diazepam (Stesolid / diazepam, Alpharma)

The Use of High-dose Diazepam in Combination With ECT for Treatment of Pediatric Catatonia.

Meierer Ellen E, Nilsson Matthew M, Gerwin Roslyn R

Benzodiazepines use in primary care England: Prescribing patterns and adverse consequences.

Chaudhry Alvina A, Khan Muhammad Umair MU, Conway Barbara B, Hasan Syed Shahzad SS

Benzodiazepines (BZDs) are commonly prescribed for anxiety and insomnia but carry risks such as dependence, adverse drug reactions (ADRs) and mortality. Despite deprescribing efforts, the influence of recent prescribing trends, COVID-19 and adverse outcomes on prescribing patterns in England remains uncertain. This study evaluates trends in BZD prescribing, costs, and safety outcomes and explores their socioeconomic associations. This population-level observational study analysed prescribing, cost and ADR data for 14 BZDs using national datasets. Prescribing rates were standardized per 100 000 population, fatality ratios were calculated, and regression models assessed yearly changes by drug, region, and pandemic phase. Socioeconomic influences on prescribing were analysed using a generalized additive model. Total BZD prescribing decreased from 15562.34 items per 100 000 population in 2020 to 12284.01 in 2025, a mean annual change of -4.3% (95% CI: -4.5% to -4.03%), largely because of reduced prescribing of diazepam, temazepam and chlordiazepoxide. Conversely, specialist-use agents increased, including clobazam (6.36% per year, 95% CI: 0.34% to 12.39%) and midazolam (1.03% per year, 95% CI: -1.30% to 3.37%). Ethnicity influenced deprivation-related prescribing patterns, indicating disparities beyond socioeconomic status. The average lifetime fatality ratio across all BZDs was 4.5 deaths per 100 reported cases, with oxazepam the highest (17.9), followed by lorazepam (9.1) and alprazolam (8.6). Benzodiazepine prescribing in England continues to decline, reflecting successful deprescribing policies. However, increasing specialist use, persistent inequities, and drug-specific safety and cost concerns highlight the need for cautious prescribing, enhanced pharmacovigilance and equitable access.

Posterior reversible encephalopathy syndrome following eclampsia in a primigravida at 35 weeks of gestation: A case report.

Chowdhury Anika A, Khan Anika Tasnim AT, Zahan Zakia Akther ZA, Tabassum Zareen Z et al.

Posterior reversible encephalopathy syndrome (PRES) is a reversible neurological disorder most commonly triggered by eclampsia and characterized on imaging by vasogenic edema, typically involving the parieto-occipital regions. We describe a 26-year-old primigravida at 35 weeks of gestation who presented with headache, dyspnea, and a generalized tonic-clonic seizure, with severe hypertension (200/110 mmHg), 3+ proteinuria, serum creatinine (1.1 mg/dL), and platelet count (100,000/mm3) consistent with severe preeclampsia with superimposed eclampsia. She underwent emergency lower-segment cesarean section (LSCS) for delivery of a live neonate, with a second intraoperative seizure controlled with intravenous diazepam and magnesium sulfate. Postoperatively, she developed sudden bilateral visual loss without focal neurological deficit. Brain MRI showed bilateral, symmetric T2- and FLAIR-hyperintense signal in the parieto-occipital white matter without evidence of restricted diffusion on DWI/ADC a pattern of vasogenic edema diagnostic of PRES. She was treated with intravenous magnesium sulfate, antihypertensive therapy, and levetiracetam, with complete clinical recovery and radiological resolution on follow-up imaging. This case highlights eclamptic PRES as a cause of postoperative cortical visual loss and illustrates how the combination of T2/FLAIR signal change with preserved diffusion on MRI distinguishes reversible vasogenic edema from ischemic injury, supporting prompt, targeted management even in resource-limited settings.

Silent acute STEMI associated with alcohol withdrawal in a 46-year-old male: a case report.

Jha Aashutosh A, Adhikari Suman S, Poudel Sishir S, Niraula Oasis O et al.

Alcohol withdrawal (AW) results from abrupt cessation or reduction in chronic alcohol use, leading to central nervous system hyperexcitability and autonomic overactivity. AW poses significant cardiovascular stress, predisposing to myocardial ischemia via various mechanisms. A 46-year-old male with chronic heavy alcohol use and no known major cardiovascular risk factors presented with restlessness. On admission, he exhibited features of moderate alcohol withdrawal, including tremors, agitation, and disorientation. He was managed supportively in the intensive care unit with a titrated diazepam infusion, resulting in gradual improvement in withdrawal symptoms. On the 10th day, a routine ECG demonstrated an acute inferior wall ST-elevation myocardial infarction (STEMI), and the qualitative troponin I test was positive, despite the absence of ischemic symptoms. The underlying mechanism of myocardial infarction could not be definitively established because coronary angiography was declined. Although recent alcohol withdrawal may have contributed through persistent physiological stress, coronary artery vasospasm, myocardial oxygen supply-demand mismatch, platelet hyperactivity, or other mechanisms remain possible. The patient was fully oriented at the time of infarction, supporting the diagnosis of a silent myocardial infarction. This case report adds to the scarce literature on acute coronary events during hospitalization for severe alcohol withdrawal and emphasizes that the patient's silent STEMI may have arisen from multiple underlying mechanisms. It highlights the importance of maintaining a high index of suspicion for silent myocardial infarction in hospitalized patients recovering from alcohol withdrawal.