Megadose bromazepam dependence.

BACKGROUND Benzodiazepines (BZDs) are among the most widely prescribed drugs in developed countries. Since BZDs can produce tolerance and dependence even in a short time, their use is recommended for a very limited time. However, these recommendations have been largely disregarded. The chronic use of BZDs causes a number of serious side effects, i.e. cognitive impairment, falls, traffic accidents, dependence and tolerance. METHODS We present the case of a 37 years old woman taking daily doses of 220 mg of bromazepam. The patient's anxiety, depression and cognitive status were evaluated with a battery of questionnaires. A sleep laboratory test was performed in search of sleep apneas and sleepiness during the day. A Cerebral PET SCAN was executed in search of altered cerebral metabolism. RESULTS Blood concentrations of bromazepam reached 7800 μg/L. Questionnaire evaluations showed significant depression and anxiety but only moderate cognitive impairment. Oxygen saturation was normal throughout the Sleep lab test, respiratory events were very few and sleepiness was moderate with an average latency of 9 minutes. Brain cortical glucose consumption was homogeneously slightly reduced. CONCLUSIONS With doses of bromazepan reaching 15 times the toxic dose, anxiety remained high. Cognition, sleepiness, respiratory sleep events and brain metabolism remained remarkably close to normal.