A DOCS Education member writes:
My 66-year-old patient is healthy and her blood pressure was 122/73. Synthroid® is her only medication and she has no known allergies. The patient states that about 40 years ago, she was given Valium® (over 10 mg) and didn't have an allergic reaction, but rather an "emotional" reaction.
She states she kept crying and was very emotional for several hours after ingestion. Have you experienced this before? Should I be concerned with administering benzodiazepines? I would like to know if I should still give the 2.5 mg Valium® the night before or just omit the Valium® and pre-medicate one hour before with the 0.125 mg triazolam.
Dr. Anthony Feck, Dean of DOCS Education Faculty responds:
I have had a couple patients report being depressed after sedation with triazolam. One of the "significant" adverse effects of most benzodiazepines is depression. These are almost always patients already predisposed to this.
It is possible that this is what your patient experienced with diazepam previously. It could also be a paradoxical reaction to the diazepam. My recommendation is to forego the diazepam the night before and just give the loading and assessment doses of triazolam on the day of the appointment. Keep in mind that it is still possible your patient will have an "emotional" reaction to the triazolam.
Dr. Leslie Fang, DOCS Education Faculty responds:
I agree with Dr. Feck that this probably represents precipitation of depression in a patient that has an underlying predisposition. This is not specific to Valium®, but to all benzodiazepines. It may also be a problem with other anxiolytics. You probably should warn the patient that this may again occur, but is expected to be short-lived.
