A 35-year-old woman with long-term therapeutic alprazolam use stops it abruptly. Two days later she develops anxiety, insomnia, hypersensitivity to light and sound, and a generalized seizure. Which pharmacological property makes diazepam suitable for treating her withdrawal?

• A Pure antagonist action allowing rapid titration
• B Long half-life permitting self-tapering during metabolism ✓
• C Absence of cross-tolerance with other benzodiazepines
• D Selective suppression of REM sleep without rebound

Explanation

Management of sedative-hypnotic withdrawal relies on substituting a long-acting benzodiazepine such as diazepam or chlordiazepoxide, then tapering slowly. The long half-life provides a built-in gradual decline in drug levels, smoothing the withdrawal curve and reducing breakthrough symptoms and seizures. Alprazolam's short half-life caused abrupt level falls that triggered this episode. Cross-tolerance among benzodiazepines is what allows substitution, not its absence, and REM rebound still occurs.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.