Depending on their duration of action, barbiturates are classified as short, ultra short, intermediate and long-acting [1] [2]. Of these, the short and intermediate-acting barbiturates like pentobarbital and secobarbital [3] are often associated with withdrawal symptoms and signs. Barbiturate withdrawal can occur following the sudden cessation of the drug. This leads to a withdrawal syndrome identical to alcohol withdrawal with delirium tremens and can even be life-threatening in some patients.

Within a day after withdrawal of barbiturates, individuals develop restlessness, weakness, and tremulousness. Symptoms progressively increase on the second day with exaggerated deep tendon reflexes. Seizures can develop within 48 to 72 hours in patients who were on very high doses of barbiturates. This can even progress to status epilepticus and sometimes death [4]. Other clinical features like confusion, delirium, auditory and visual hallucinations, hyperpyrexia, circulatory collapse, and dehydration may occur between 48 to 120 hours after withdrawal [5].

Compared to alcohol withdrawal syndrome, barbiturate withdrawal is more variable and delayed [4] and patients can develop multiple seizures and delirium.

• Fever

  Some Withdrawal Symptoms Include: Tremors Difficulty sleeping Agitation Hallucinations Fever Fatigue Seizures Barbiturates can build up in the human body and as a person ages, the body becomes less able to cleanse itself of barbiturates. [avalonmalibu.com]

  Orally Drowsiness Headache Depression Excitement Joint or muscle pain Upset stomach Diarrhea Constipation Skin Rash Itching Sore throat Fever Easy bruising Bloody nose Unusual bleeding Confusion, hallucinations Weak or shallow breathing Slow heart rate [solutions-recovery.com]

  Barbiturates Bleeding sores on lips Chest pain Fever Muscle or joint pain Red, thickened, or scaly skin Skin rash or hives Sores, ulcers, or white spots in mouth (painful) Sore throat and/or fever Swelling of eyelids, face, or lips Wheezing or tightness [blog.palmpartners.com]

  Mid Withdrawal: Progressing to include tremor, fever, diaphoresis, insomnia, anorexia, and diarrhea. [essentialsofcorrectionalnursing.com]

  Miscellaneous: pruritus, fever, earache, nasal congestion, tinnitus, euphoria, allergic reactions. Several cases of dermatological reactions, including toxic epidermal necrolysis and erythema multiforme, have been reported. [rxlist.com]

• Nightmare

  Psychological symptoms include increased anxiety, panic attacks, rage, insomnia, nightmares, and depression. [intheknowzone.com]

  Between days three and eight, many people go through hallucinations, nightmares, insomnia, shortness of breath, and rapid heartbeats. Your medical professionals need to help you through this period, which usually lasts less than eight days. [crchealth.com]

  Because barbiturates decrease rapid eye movement during sleep, during which dreaming takes place, withdrawal can results in sleep disruptions such as nightmares, insomnia or vivid dreaming. [castlecraig.co.uk]

  Less common side effects include agitation, confusion, breathing difficulties, abnormally low blood pressure, nausea, vomiting, constipation, lower body temperature, decreased heart rate, movement difficulty, nightmares, anxiety, nervousness, mental depression [minddisorders.com]

  Sparkles is aware that in some countries (the US in particular) that money for treatment can be a bloody nightmare, but there re free hospitals there so she would head there. [drugs-forum.com]

• Nausea

  Nausea. Vomiting. Anxiety. Tremors or shaking. Rapid heart rate. Seizures. [withdrawal.net]

  Symptoms are flu-like, and include gastrointestinal distress, anxiety, nausea, insomnia, muscle pain, fevers, sweating, and runny nose and eyes. [intheknowzone.com]

  According to the Diagnostic and Statistical manual of mental disorders (DSM) - 5, the criteria for barbiturate withdrawal are the following: Reduction or cessation of use of sedative Two or more of the following symptoms: autonomic hyperactivity, insomnia, nausea [symptoma.com]

  Barbiturates withdrawal symptoms can include restlessness, insomnia, weakness, dizziness, nausea, sweating and anxiety. There may be tremors, seizures, hallucinations and psychosis. Users may become hostile and violent. [patmoorefoundation.com]

  Barbiturate Side Effects Common side effects of barbiturates include: Sedation Dizziness and lightheadedness Headache Nausea or abdominal pain Barbiturate 'High' and Abuse Barbiturates can be habit-forming and addictive. [everydayhealth.com]

• Tachycardia

  Cardiovascular: tachycardia. Musculoskeletal: leg pain, muscle fatigue. Genitourinary: diuresis. Miscellaneous: pruritus, fever, earache, nasal congestion, tinnitus, euphoria, allergic reactions. [rxlist.com]

  Signs and symptoms associated with amphetamine use include mydriasis (dilated pupils), sweating, increased temperature, tachycardia (rapid pulse), and hypertension. [medical.tpub.com]

  Symptoms are similar to those of alcohol withdrawal and include tachycardia, seizures, tremor, and hyperreflexia. [emedicine.medscape.com]

  The reaction to disulfiram is characterized by headache, diaphoresis, tachycardia, nausea and vomiting, cardiovascular collapse, delirium, seizures and, occasionally, death. [aafp.org]

• Hypertension

  Signs and symptoms associated with amphetamine use include mydriasis (dilated pupils), sweating, increased temperature, tachycardia (rapid pulse), and hypertension. [medical.tpub.com]

  This drug is used for hypertension and to treat withdrawal from opiate narcotics. [encyclopedia.com]

  […] insomnia, elevated blood pressure and pulse (mild) Intense desire for drugs, muscle cramps, arthralgia, anxiety, nausea, vomiting, malaise PCP/psychedelics Days to weeks Days to weeks Hyperactivity, increased pain threshold, nystagmus, hyperreflexia, hypertension [aafp.org]

  […] biogenic amine (DA, NE, 5HT) reuptake Intoxication presentation mental status changes euphoria, psychomotor agitation, grandiosity, hallucinations (including tactile), paranoid ideations sympathetic activation ↓ appetite, tachycardia, pupillary dilation, hypertension [medbullets.com]

• Low Self-Esteem

  Treatment programs also address the underlying causes of the addiction such as depression, anxiety or low self-esteem. Patients in barbiturate withdrawal treatment programs receive support from medical professionals, counselors and other patients. [livingsober.com]

• Seizure

  Spontaneous generalized or partial seizures occurred during withdrawal; the abnormal EEG patterns associated with seizures appeared to originate in various subcortical sites. [ncbi.nlm.nih.gov]

  seizure, chance, syndrome, severity, withdrawal, barbiturate withdrawal, chance of serious barbiturate withdrawal, serious barbiturate withdrawal, phenobarbitol 5: Antipsychotics are not recommended for barbiturate withdrawal (or other CNS depressant [www3.lymba.com]

  It is essential to diagnose barbiturate withdrawal quickly, otherwise seizures, delirium, and death may follow. [symptoma.com]

  Seizures – Seizures can occur at any point during the barbiturate withdrawal timeline. Often, a person will be tapered off of barbiturates instead of stopping abruptly to help prevent seizures and minimize other symptoms. [withdrawal.net]

• Tremor

  Symptoms include anxiety, restlessness, insomnia, rhythmic intention tremor, dizziness, seizures, and psychosis. If the syndrome is not recognized and correctly treated, hyperthermia, circulatory failure, and death may ensue. [ncbi.nlm.nih.gov]

  During detox, other medical and psychiatric medications will be prescribed to control symptoms such as high heart rate and blood pressure, anxiety, depression, insomnia, muscle cramping, tremors, etc. [recoveryconnection.com]

  Mid Withdrawal: Progressing to include tremor, fever, diaphoresis, insomnia, anorexia, and diarrhea. [essentialsofcorrectionalnursing.com]

  Stopping cold turkey can result in life threatening seizures, tremors, and muscle cramps. Therefore, it is important to taper off benzodiazepines very slowly with professional help. [blog.palmpartners.com]

• Confusion

  Respiratory depression, hypotension, fatigue, irritability, sedation, confusion and unusual excitement are all possible effects and repercussions of using barbiturates. [avalonmalibu.com]

  The confusion is similar to that seen during alcohol withdrawal, known as delirium tremens (DTs). People who are withdrawing may experience anxiety, disorientation, and visual hallucinations. [medicalnewstoday.com]

  Other clinical features like confusion, delirium, auditory and visual hallucinations, hyperpyrexia, circulatory collapse, and dehydration may occur between 48 to 120 hours after withdrawal. [symptoma.com]

  ROUND 1 Health Effects Benzodiazepines •Diazepam (Valium) •Chlordizapoxide HCI (Librium) •Alprazolam (Xanax) •Triazolam (Halcion) •Estazolam (ProSom) Side effects of benzodiazepine may include: Drowsiness Confusion Dizziness Trembling Impaired coordination [blog.palmpartners.com]

  In larger amounts, speech difficulties, confusion, poor decision making and staggering can result. [rehabthailand.com]

• Agitation

  […] and Statistical manual of mental disorders (DSM) - 5, the criteria for barbiturate withdrawal are the following: Reduction or cessation of use of sedative Two or more of the following symptoms: autonomic hyperactivity, insomnia, nausea, psychomotor agitation [symptoma.com]

  […] are present Tremulousness, insomnia, agitation are present Tremulousness, insomnia, agitation are present TABLE 2 Medications for Alcohol Detoxification Mild withdrawal Moderate withdrawal Severe withdrawal (delirium tremens)* Loading-dose method Diazepam [aafp.org]

  Symptoms of barbiturate withdrawal include: Tremors and shaking Agitation Difficulty sleeping Your doctor will probably advise you to stop taking the drugs gradually over a period of time. [everydayhealth.com]

  Benzodiazepines occasionally fail to control alcohol withdrawal, and may promote agitated delirium. In contrast, phenobarbital is more effective and doesn't cause paradoxical agitation. [emcrit.org]

  Barbiturates withdrawal symptoms may include: Tremors and shakiness Insomnia Agitation Hallucinations Violent behavior Extremely high body temperature Seizures Respiratory depression Respiratory arrest Coma Death Treatment for Barbiturate Withdrawals [livingsober.com]

• Nystagmus

  Barbiturate use classically causes various degrees of CNS depression with nystagmus (eyes moving up and down, or side-to-side involuntarily), vertigo (sensation of the room spinning), slurred speech, lethargy, confusion, ataxia (difficulty walking) and [medical.tpub.com]

  On physical exam, the patient is agitated and has nystagmus. His blood pressure in the ED is 180/100 mmHg. [medbullets.com]

  We have added green lines indicating the plasma therapeutic range for phenobarbital (64-172 micromol/L = 15-40 ug/ml), an orange line indicating the level at which mild signs of toxicity are usually noted such as ataxia and nystagmus (225 micromol/L = [emcrit.org]

  lacrimation, diarrhea, insomnia, elevated blood pressure and pulse (mild) Intense desire for drugs, muscle cramps, arthralgia, anxiety, nausea, vomiting, malaise PCP/psychedelics Days to weeks Days to weeks Hyperactivity, increased pain threshold, nystagmus [aafp.org]

History is the most important part of the workup, with the diagnosis being based on clinical findings. It is essential to diagnose barbiturate withdrawal quickly, otherwise seizures, delirium, and death may follow [5]. According to the Diagnostic and Statistical manual of mental disorders (DSM) - 5 [6], the criteria for barbiturate withdrawal are the following:

1. Reduction or cessation of use of sedative
2. Two or more of the following symptoms: autonomic hyperactivity, insomnia, nausea, psychomotor agitation, anxiety, in addition to symptoms already mentioned, developing within hours to days after cessation
3. Symptoms and signs mentioned in criterion 2 result in impairment of social, occupational or other functions
4. The signs and symptoms cannot be due to any other medical condition, mental disorders, intoxication or withdrawal from other substances.

It is important for the physician to elicit a history of the exact barbiturate used/abused, duration of illicit usage or abuse, when it was last ingested, was the drug discontinued suddenly or accidentally, treatment received for withdrawal symptoms, and whether other substances like alcohol were also ingested.

Urine toxicology is performed in all cases and may help to detect other substances consumed along with the barbiturates. Most laboratories are unable to measure blood levels of barbiturates except phenobarbital. Routine laboratory tests like a complete blood cell count (CBC), serum electrolytes, blood urea nitrogen, serum creatinine, and blood glucose levels are obtained to exclude metabolic syndromes which cause symptoms identical to barbiturate withdrawal. Arterial blood gas (ABG) analysis is useful to diagnose metabolic acidosis and respiratory failure while serum lactic acid level helps to evaluate perfusion at the cellular level. A urine pregnancy test should be performed in all women in the childbearing age group.

If you or a loved one needs to find out more about barbiturate addiction treatment as well as treatment for addiction to other substances used along with barbiturates, please call our toll-free helpline for substance addiction treatment and recovery at [projectknow.com]

Ultimately, any delay in getting the right treatment can lead to death. Emergency Treatment Of Barbiturate Withdrawal As a matter of fact, medications form the mainstay of Barbiturate withdrawal treatment. [addictionresource.com]

Learn more about barbiturate withdrawal treatment options and medications. Recovery From Barbiturate Addiction Call Now: 1-888-935-1318 Who Answers? Discuss treatment options with a helpline representative. [withdrawal.net]

Abstract Barbiturate withdrawal seizure susceptibility in rats increased with increasing duration of treatment during a 15-day treatment period in which the animals were given an i.p. dose of sodium barbital every 12 h. [ncbi.nlm.nih.gov]

A person's outcome, also called prognosis, after abusing barbiturates depends on a number of factors. [emedicinehealth.com]

ETIOLOGY Not all patients who take benzodiazepines will experience a discontinuance syndrome when the drug is stopped. Several conditions must be present before the discontinuance syndrome is likely: Duration of treatment. [encyclopedia.com]

Epidemiology of alcohol use and alcoholrelated consequences. In: Alcohol and health. Eighth special report to the U.S. Congress from the Secretary of Health and Human Services. September 1993:1–35. ... 2. Bennett JC, Plum F, eds. [aafp.org]

Search through current and concise descriptions of pathophysiology of diseases and their impact on anesthesia! Gain expertise in understanding the impact of pathophysiology of coexisting diseases on anaesthesia! [books.google.com]

This dual mechanism of action is well matched to the pathophysiology of alcohol withdrawal, making barbiturates theoretically superior to benzodiazepines.. Clinical experience: Barbiturates are more powerful than benzodiazepines. [emcrit.org]

Toggle Nav We go beyond testing to provide you with the information and resources you need to understand and prevent drug abuse. [firstcheckfamily.com]

Barbiturates Image courtesy of the Indiana Prevention Resource Center Barbiturates Image courtesy of the Indiana Prevention Resource Center Behavioral Effects of Barbiturates Barbiturates have several effects on behavior depending on the dose: In low [faculty.washington.edu]

Medical assistance is often recommended for barbiturate withdrawal to reduce the severity of withdrawal symptoms and prevent life-threatening consequences. [withdrawal.net]

The dosage of pentobarbital is gradually reduced until the patient is no longer dependent on it to prevent withdrawal symptoms. [projectknow.com]

To prevent seizures and other problems, withdrawal is accomplished by gradual reduction of the dose. Start withdrawing the patient on diazepam (Valium), 15 to 25 mg four times daily. [mentalhealth.com]

1. Martin PR, Kapur BM, Whiteside EA et al. Intravenous phenobarbital therapy in barbiturate and other hypnosedative withdrawal reactions: a kinetic approach. Clin Pharmacol Ther 1979; 26: 356-364
2. Fitch RH, Tatum AL. The duration of action of the barbituric acid hypnotics as a basis of classification. J Pharmacol Exp Ther 1932; 44: 325-335 25. Ewing JA, Bakewell WE: Diagnosis and management of depressant drug dependence. Am J Psychiatry 1967; 123: 909-917
3. Ewing JA, Bakewell WE: Diagnosis and management of depressant drug dependence. Am J Psychiatry 1967; 123: 909-917
4. Wolff MH (ed): The Barbiturate Withdrawal Syndrome, Munksgaard, Copenhagen, 1959
5. Sarrecchia C1, Sordillo P, Conte G, Rocchi G.Barbiturate withdrawal syndrome: a case associated with the abuse of a headache medication. Ann Ital Med Int. 1998 Oct-Dec; 13(4):237-239
6. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Association. 2013; 550-560.