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In rare susceptible individuals, midazolam has been known to cause a paradoxical reaction, a well-documented complication with benzodiazepines. When this occurs, the individual may experience anxiety, involuntary movements, aggressive or violent behavior, uncontrollable crying or verbalization, and other similar effects.
A paradoxical reaction (or paradoxical effect) is an effect of a chemical substance, such as a medical drug, that is opposite to what would usually be expected. An example of a paradoxical reaction is pain caused by a pain relief medication .
Paradoxical reactions are rare in the general population, with an incidence rate below 1% and similar to placebo. [ 8 ] [ 116 ] However, they occur with greater frequency in recreational abusers, individuals with borderline personality disorder , children, and patients on high-dosage regimes.
Paradoxical disinhibition is a paradoxical reaction, an uncommon but recognized phenomenon, characterized by acute excitement and an altered mental state, caused by benzodiazepines. The mechanism is poorly known, but the most accepted theory is that it occurs secondary to inhibition of the restraining influences of the cortex and frontal lobe ...
Others must be bioactivated into a toxic compound that will in turn bind to proteins. The second criterion of cellular damage can come either from a toxic drug/drug metabolite, or from an injury or infection. These will sensitize the immune system to the drug and cause a response. Idiosyncratic reactions fall conventionally under toxicology.
These effects are paradoxical to the use of benzodiazepines, both clinically and non-medically, in management of mental health conditions. [44] [45] Long-term benzodiazepine use may lead to the creation or exacerbation of physical and mental health conditions, which improve after six or more months of abstinence.
Adverse drug reaction (ADR), a harmful unintended result caused by taking medication; Combined drug intoxication; Conservative management; Drug-drug interaction (DDI), an alteration of the action of a drug caused by the administration of other drugs; Paradoxical reaction, an effect of a substance opposite to what would usually be expected
Malcolm Lader at the Institute of Psychiatry in London estimates the incidence of these adverse reactions at about 5%, even in short-term use of the drugs. [23] The paradoxical reactions may consist of depression, with or without suicidal tendencies, phobias, aggressiveness, violent behavior and symptoms sometimes misdiagnosed as psychosis.