| Barbiturate dependence | |
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| Specialty | Psychiatry,narcology,addiction medicine  |
Barbiturate dependence develops with regular use ofbarbiturates. This in turn may lead to a need for increasing doses of the drug to get the original desired pharmacological or therapeutic effect.[1] Barbiturate use can lead to bothaddiction andphysical dependence, and as such they have a high potential for excess or non-medical use,[2] however, it does not affect all users. Management of barbiturate dependence involves considering the affected person's age, comorbidity and the pharmacological pathways of barbiturates.[3]
Psychological addiction to barbiturates can develop quickly. The patients will then have a strong desire to take any barbiturate-like drug. The chronic use of barbiturates leads to moderate degradation of the personality with narrowing of interests, passivity and loss ofvolition. The somatic signs includehypomimia, problems articulating, weakening of reflexes, andataxia.[4]
TheGABAA receptor, one of barbiturates' main sites of action, is thought to play a pivotal role in the development of tolerance to and dependence on barbiturates, as well as theeuphoric "high" that results from their use.[2] The mechanism by which barbiturate tolerance develops is believed to be different from that ofethanol orbenzodiazepines, even though these drugs have been shown to exhibit cross-tolerance with each other[5] andpoly drug administration of barbiturates andalcohol used to be common.
The management of aphysical dependence on barbiturates is stabilisation on the long-acting barbituratephenobarbital followed by a gradual titration down of dose. People who use barbiturates tend to prefer rapid-acting barbiturates (amobarbital, pentobarbital, secobarbital) rather than long-acting barbiturates (barbital, phenobarbital).[6] The slowly eliminated phenobarbital lessens the severity of the withdrawal syndrome and reduces the chances of serious barbiturate withdrawal effects such asseizures.[7] Acold turkey withdrawal can in some cases lead to death. Antipsychotics are not recommended for barbiturate withdrawal (or other CNS depressant withdrawal states) especiallyclozapine,olanzapine or low potencyphenothiazines e.g.chlorpromazine as they lower the seizure threshold and can worsen withdrawal effects; if used extreme caution is required.[8] The withdrawal symptoms after ending barbiturate consumption are quite severe and last from 4 to 7 days.
| Addiction |
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| Dependence |
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| Treatment and management |
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