Barbiturate Withdrawal Symptoms and Side Effects
People who have become physically dependent on barbiturates will experience withdrawal effects when they stop using them or lower the dose.
Takeaways from this article:
Barbiturate withdrawal timeline
Barbiturate withdrawal symptoms
Barbiturates health risks
Barbiturates are sedative medications that have been largely phased out in favor of benzodiazepines due to problems with abuse and overdose. 4 In the past, barbiturates were widely used to treat anxiety and insomnia. They continue to be used today as anesthetic agents, as well as for managing headaches, seizures, convulsions, and withdrawal from other substances.3
Despite their decline in medical use, barbiturates are still abused and led to more than 18,000 emergency room visits in 2011.5 Regular users of barbiturates rapidly develop tolerance and find that they need more of the drug to achieve the same effect. Prolonged use, especially at high doses, can lead to physical dependence, in which the person’s system begins to rely on the drug’s presence. 6
Symptoms of Barbiturate Withdrawal & Timeline
A person going through barbiturate withdrawal may experience insomnia, nausea, anxiety, tremors, and seizures. People who have become physically dependent on barbiturates will experience withdrawal effects when they stop using them or lower the dose. Barbiturate withdrawal symptoms can include seizures, and in some instances, death. 6 The symptoms begin within 1-3 days and can last up to 2 weeks or more.
Some of the more common symptoms include restlessness, agitation, insomnia, weakness, nausea, vomiting, anxiety, tremors or shaking, rapid heart rate, seizures, hallucinations.6,7
- Signs and symptoms will begin to appear within 3 days after stopping use.
- Symptoms intensify, and seizures may occur. Other symptoms include anxiety, weakness, sweating, insomnia, and delirium.
- Symptoms begin to fade but can last up to 2 weeks.
- Symptoms generally go away, but as noted above, some users may experience troublesome symptoms after the initial withdrawal period.
Risk Factors Associated with Barbiturate Withdrawal
Barbiturate withdrawal signs and symptoms can be more severe in people who have other medical complications or psychiatric disorders. People who have been using for a longer period of time or using a very high dose are also more likely to have severe barbiturate withdrawal effects. In addition, people who use multiple substances – especially opioids and alcohol – may experience more severe withdrawal. 7
Most of the barbiturate withdrawal signs should fully resolve after about 14 days.8 However, some people can experience post-acute withdrawal symptoms including:
- Cognitive impairment including difficulty making decisions, poor memory, and lack of attention. 9
In some cases, these symptoms can last for a year or more. But they generally fade if the person remains abstinent from barbiturate use. 9 It is helpful to maintain treatment after the initial withdrawal so that post-acute withdrawal symptoms can be identified and treated.
Barbiturate withdrawal effects can lead to medical complications, especially among people who have prior medical conditions, abuse other substances in addition to barbiturates, or are elderly. However, withdrawal-related complications can happen to anyone. Appropriate medical supervision and treatment during withdrawal can help prevent many medical complications.
Some of the complications that can occur include:
- Dehydration – A person can easily become dehydrated during withdrawal when experiencing a lot of nausea, vomiting, or diarrhea. If a person is having a hard time taking in adequate fluids during the withdrawal period, the risk for dehydration is very high and can be very dangerous. However, medical treatment can manage the symptoms and help to restore fluid balance.
- Depression or anxiety – Barbiturate withdrawal is sometimes associated with changes in mental health, some of which can outlast other symptoms. Anxiety and depression are common during barbiturate withdrawal, as is insomnia. Barbiturate withdrawal can also cause psychotic episodes during which a person loses the ability to tell what is real from what is not.
- Seizures – Seizures can occur at any point during the barbiturate withdrawal timeline. Often, a person will be tapered off of barbiturates instead of stopping abruptly to help prevent seizures and minimize other symptoms.
- Risk of overdose – If a person relapses during barbiturate withdrawal, they are vulnerable to overdose if they attempt to use the dose they became accustomed to previous to detox. When a person relapses, they do not have the same tolerance that they did before getting clean. Barbiturates have a narrow threshold between a therapeutic dose and an overdose, so it is often a small difference between a dose that will be intoxicating and a dose that will be deadly.
. McKeown, N. J. and West, P. L. (2016) Withdrawal Syndromes Clinical Presentation.
. Substance Abuse and Mental Health Services Administration (2013). Detoxification and Substance Abuse Treatment.
. Lopez-Munoz, F., Ucha-Udabe, R., and Alamo, C. (2005). The history of barbiturates: a century after their clinical introduction. Neuropsychiatric Disease and Treatment 1(4):329-343.
. Bernardy, N. (2013). The Role of Benzodiazepines in the Treatment of Posttraumatic Stress Disorder (PTSD). PTSD Research Quarterly 23(4).
. Substance Abuse and Mental Health Services Administration. (2013). Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits.
. European Monitoring Centre for Drugs and Drug Addiction. (2015). Barbiturates drug profile.
. Herron, A. and Brennan, T. (2015). The ASAM Essentials of Addiction Medicine. Wolters Kluwer.
. Doweiko, H. (2011). Concepts of Chemical Dependency. Cengage Learning.
. Hajela, R., Abbott, P., and Newton, S. (2015). Addiction Is Addiction: Understanding the disease in oneself and others for a better quality of life. Friesen Press.
. Saddock, B., and Saddock, V. (2008). Kaplan and Saddock’s Concise Textbook of Clinical Psychiatry. Lippincott Williams & Wilkins.