SHM Converge Scientific Abstract ePoster Gallery-Bromazolam Withdrawal: Navigating Uknown Territory in Designer Benzodiazepine Dependence

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This case describes a 39-year-old man with benzodiazepine use disorder, anxiety, and PTSD who developed a seizure after abrupt bromazolam withdrawal. He had been prescribed benzodiazepines years earlier, then transitioned to illicit bromazolam and had been tapering by 10% weekly from 24 mg/day to 14 mg/day. After traveling without the drug, he seized 48 hours after his last dose and was admitted to the ICU.<br /><br />Toxicology and Addiction Medicine initiated the Minnesota Detoxification Scale (MINDS) protocol with symptom-triggered phenobarbital. Despite receiving 15 mg/kg, he had another seizure. Over four days he received a total of 30 mg/kg phenobarbital, but continued to have significant withdrawal symptoms including anxiety, insomnia, and tachycardia. Because phenobarbital alone was insufficient, scheduled benzodiazepines were added on hospital day 4, which finally controlled symptoms.<br /><br />The case highlights the difficulty of managing withdrawal from designer benzodiazepines such as bromazolam, which is increasingly found in illicit supplies and is not detected on standard toxicology screens. Pharmacologically, chronic benzodiazepine use can downregulate endogenous GABA signaling, making withdrawal severe and sometimes refractory. Phenobarbital can help because it directly activates GABA-A receptors, does not rely on endogenous GABA, and has a long half-life, but some patients still require additional benzodiazepines.<br /><br />The patient ultimately required careful coordination with community clinicians to support an outpatient taper. He was discharged on diazepam 20 mg twice daily with plans for a slow taper managed by an addiction medicine clinician locally.<br /><br />Overall, the report emphasizes that bromazolam withdrawal may require individualized inpatient stabilization, phenobarbital may not be sufficient alone, and safe discharge often depends on close outpatient collaboration for prolonged tapering.

Asset Subtitle

Tara K. Ward

Meta Tag

Author List Jacob Altholz, Jess Coulter, Lynne Rosenberg, Scott Saunders, Tara K. Ward

Category Clinical Vignettes

Concept Designer Benzodiazepine Withdrawal

Concept Phenobarbital

Concept Seizure Risk

Concept Inpatient Stabilization

Concept Refractory Withdrawal

Distinguished Non-Finalist

Presenter Organization University of Colorado Hospital

Presenting Author Tara K. Ward

Track Adult

Keywords

bromazolam withdrawal

benzodiazepine use disorder

withdrawal seizure

phenobarbital protocol

MINDS scale

designer benzodiazepines

ICU admission

GABA-A receptors

diazepam taper

addiction medicine

Designer Benzodiazepine Withdrawal

Phenobarbital

Seizure Risk

Inpatient Stabilization

Refractory Withdrawal