- Last edited on June 29, 2020
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meds:paradoxical-reactions [on June 29, 2020] |
meds:paradoxical-reactions [on September 9, 2020] (current) |
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| **Paradoxical Reactions** are an unintended, paradoxical response to a medication. In the case of benzodiazepines, it can result in excessive movements, agitation, talkativeness, impulsivity, irritability, and/or excitement (the opposite of a benzodiazepine's intended effect). The incidence of paradoxical reactions are rare, at less than 1%. However, the //failure// to identify paradoxical reactions may lead to a vicious cycle of progressive titration of benzodiazepines, with worsening symptoms. | **Paradoxical Reactions** are an unintended, paradoxical response to a medication. In the case of benzodiazepines, it can result in excessive movements, agitation, talkativeness, impulsivity, irritability, and/or excitement (the opposite of a benzodiazepine's intended effect). The incidence of paradoxical reactions are rare, at less than 1%. However, the //failure// to identify paradoxical reactions may lead to a vicious cycle of progressive titration of benzodiazepines, with worsening symptoms. | ||
| - | ===== Mechanism ===== | + | ==== Risk Factors ==== |
| - | The exact mechanism for paradoxical reactions remains poorly understood. | + | Risk factors for paradoxical responses include age (pediatric or geriatric), genetic predisposition, history of significant alcohol use, and being given large benzodiazepine doses. In pediatrics, the risk of paradoxical responses to benzodiazepines are most associated with age and dose. The younger the individual, the greater the risk of having atypical reactions. Higher doses are also more likely to cause a paradoxical response.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820591/|Kirkpatrick, D., Smith, T., Kerfeld, M., Ramsdell, T., Sadiq, H., & Sharma, A. (2016). Paradoxical reaction to alprazolam in an elderly woman with a history of anxiety, mood disorders, and hypothyroidism. Case reports in psychiatry, 2016.]])][([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726857/|Shin, Y. H., Kim, M. H., Lee, J. J., Choi, S. J., Gwak, M. S., Lee, A. R., ... & Choi, J. H. (2013). The effect of midazolam dose and age on the paradoxical midazolam reaction in Korean pediatric patients. Korean journal of anesthesiology, 65(1), 9.]])] Other risk factors include individuals with autism, learning disabilities, and neurological disorders.[([[https://www.ncbi.nlm.nih.gov/pubmed/2826308|Marrosu, F., Marrosu, G., Rachel, M. G., & Biggio, G. (1987). Paradoxical reactions elicited by diazepam in children with classic autism. Functional neurology, 2(3), 355-361.]])] |
| - | ===== Risk Factors ===== | ||
| - | Risk factors for paradoxical responses include age (pediatric or geriatric), genetic predisposition, history of significant alcohol use, and being given large benzodiazepine doses. | ||
| - | In pediatrics, the risk of paradoxical responses to benzodiazepines are most associated with age and dose. The younger the individual, the greater the risk of having atypical reactions. Higher doses are also more likely to cause a paradoxical response.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820591/|Kirkpatrick, D., Smith, T., Kerfeld, M., Ramsdell, T., Sadiq, H., & Sharma, A. (2016). Paradoxical reaction to alprazolam in an elderly woman with a history of anxiety, mood disorders, and hypothyroidism. Case reports in psychiatry, 2016.]])][([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726857/|Shin, Y. H., Kim, M. H., Lee, J. J., Choi, S. J., Gwak, M. S., Lee, A. R., ... & Choi, J. H. (2013). The effect of midazolam dose and age on the paradoxical midazolam reaction in Korean pediatric patients. Korean journal of anesthesiology, 65(1), 9.]])] Other risk factors include individuals with autism, learning disabilities, and neurological disorders.[([[https://www.ncbi.nlm.nih.gov/pubmed/2826308|Marrosu, F., Marrosu, G., Rachel, M. G., & Biggio, G. (1987). Paradoxical reactions elicited by diazepam in children with classic autism. Functional neurology, 2(3), 355-361.]])] | + | ===== Mechanism ===== |
| + | The exact mechanism for paradoxical reactions remains poorly understood. It is hypothesized that paradoxical reactions may be the same phenomenon related to increased risk of suicidal ideation from antidepressant use in children. | ||
| ===== Management ===== | ===== Management ===== | ||