Sedative poisoning and the sedative-hypnotic toxidrome
Recognising the sedative-hypnotic toxidrome and its mimics, risk assessment by agent (benzodiazepines, Z-drugs, alprazolam, baclofen, gabapentinoids, barbiturates, GHB, chloral hydrate), supportive care and airway decisions, when flumazenil is and isn't safe, and enhanced elimination.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- The sedative-hypnotic toxidrome: reduced consciousness, ataxia, slurred speech and nystagmus with near-normal vital signs and normal pupils.
- Most pure benzodiazepine or Z-drug overdoses need only observation and airway care. Deep coma or apnoea means a co-ingestant, until proven otherwise.
- Death comes from airway loss and aspiration, combinations with opioids or alcohol, and complications of a long lie.
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Sources
- Therapeutic Guidelines: Toxicology and Toxinology (December 2024 update, including EXTRIP-based haemodialysis advice for baclofen)AU/NZTherapeutic Guidelines Limited, 2024
- Poisons Information Centre (13 11 26)AU/NZNSW Poisons Information Centre, Sydney Children's Hospitals Network
- Isbister GK et al. Alprazolam is relatively more toxic than other benzodiazepines in overdose. Br J Clin Pharmacol 2004;58:88-95AU/NZBritish Journal of Clinical Pharmacology, 2004
- Gomes T et al. Gabapentin, opioids, and the risk of opioid-related death. PLoS Med 2017;14:e1002396PLOS Medicine, 2017
- Mactier R et al. Extracorporeal treatment for barbiturate poisoning: recommendations from the EXTRIP Workgroup. Am J Kidney Dis 2014;64:347-58American Journal of Kidney Diseases, 2014
- Ghannoum M et al. Recommendations from the EXTRIP workgroup on extracorporeal treatment for baclofen poisoning. Kidney Int 2021;100:720-36Kidney International, 2021
- Last updated
- 14 November 2026
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