Antidote for alprazolam9/5/2023 31, 32 It appears that slow tapering over weeks to months may be preferred. Withdrawal reactions may be avoided by gradually tapering the medication, although there is no consensus benzodiazepine tapering method, including the length of time to taper. For patients with an acute organic brain syndrome, a history of possible benzodiazepine withdrawal always should be pursued. Serious manifestations, including confusion, disorientation, psychosis, and seizures, also have been reported. Reported withdrawal manifestations include anxiety, irritability, insomnia, nausea, vomiting, tremor, sweating, and anorexia. False-positive benzodiazepine urine drug screens have been reported with oxaprozin and sertraline, although improved immunoassay techniques have reduced this potential interference. Thus, detection of a benzodiazepine agent taken in the recent past may not correctly identify the toxicologic cause of the patient's current condition. A urine benzodiazepine screen can usually detect a short-acting agent (e.g., lorazepam) up to 3 days and a long-acting agent (e.g., diazepam) up to 30 days after ingestion. 22 Depending on the antibody specificity used in the immunoassay, a false-negative test can occur and is commonly seen with midazolam and flunitrazepam. Qualitative testing with urine drug screens is typically designed to identify major metabolites of most benzodiazepines, such as oxazepam, temazepam, or nordiazepam, and not the parent compound. Serum benzodiazepine levels do not correlate well with the clinical state, so serum level measurement is not routinely indicated. Toxicologic testing in benzodiazepine ingestion is of limited value. Oral Dose Equivalents in Milligrams to Diazepam 10 Milligrams
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