Alprazolam 의 급성 금단에 따른 금단 증후군

Withdrawal Syndrome after Abrupt Discontinuation of Alprazolam

This is a clinical report of a case of an alprazolam withdrawal syndrome developed in a 43 year-old female patient who had been taking alprazolam 6 to 20 mg daily for more than 3 years, and abruptly discontinued the drug due to incidental major surgery (hysterectomy). The withdrawal symptoms had an abrupt onset 20 hours after her last dose of alprazolam, which were characterized by delirium, anxiety, irritability, fearfulness, sweating, sleep disturbance, bizarre behaviors, desultory speech, visual and auditory hallucinations, occular fluttering, tremor, and muscle twitchings. The patient was successfully managed by collaboratory work of both gynecologist and psychiatrist in less than 3 weeks’ course of treatment. The initial phase of treatment was consisted of general supportive care and vigorous replacement therapy with high dose of lorazepam which was later shifted to diazepam, and then was tapered gradually. Additionally, small dose of a new antidepressant, trazodone, was administered to control underlying depression. Alprazolam, a new triazolobenzodiazepines, has been claimed to be an effective and safe anxiolytic and/or antidepressant with minimal adverse effects and addictive properties. However it is not widely appreciated that withdrawal syndrome can occur with this drug, and only few reports of alprazolam withdrawal reaction have existed in the literature. These types of agents are becoming one of the most widely prescribed drugs in medical practice, and their potential risks must be emphasized