Pregnant, Substance-Using Women
Treatment Improvement Protocol (TIP) Series 2

Guideline 6 -- Sedative-Hypnotic Medical Withdrawal

Inpatient medical withdrawal from barbiturates, benzodiazepines, and other sedative-hypnotic drugs is recommended because continual monitoring of the mother and the fetus is required. Drug doses must be tapered so that mother and fetus arrive at a drug-free state without experiencing an uncontrolled withdrawal.

Barbiturates and benzodiazepines are the most commonly abused sedative-hypnotics. There are marked similarities between the withdrawal syndromes seen with both of these drugs. Patients abruptly withdrawn from large doses of benzodiazepines may sustain withdrawal symptoms that closely resemble those associated with barbiturate physical dependence. Because of these similarities, only the barbiturate abstinence syndrome is presented in this guideline.

Symptoms of Barbiturate Abstinence Syndrome

The barbiturate abstinence syndrome begins 6 to 24 hours after the last dose, and symptoms are generally more severe with the short-acting barbiturates. Signs and symptoms of barbiturate abstinence include Tremulousness Diaphoresis Anxiety Postural hypotension Insomnia Grand mal convulsions (between days 3 and 7) Agitation Anorexia Delirium Nausea and vomiting Tendon hyperreflexia If untreated, withdrawal symptoms can progress to hyperpyrexia, electrolyte abnormalities, cardiovascular collapse, and death.