Abstract
Background
Carisoprodol, a centrally acting muscle relaxant with a high abuse potential, has
barbiturate-like properties at the GABA-A receptor, leading to central nervous system
depression and desired effects. Its tolerance and dependence has been previously demonstrated
in an animal model, and withdrawal has been described in several recent case reports.
Many cases can be effectively managed with a short course of benzodiazepines or antipsychotic
agents. However, abrupt cessation in a patient with a history of long-term and high-dose
carisoprodol abuse may result in symptoms that are more difficult for providers to
treat.
Case Report
We present a case of a 34-year-old man with a long history of carisoprodol abuse who
was found unresponsive after having ingested 7.5 grams of carisoprodol. He was intubated
and admitted to the intensive care unit. He was given propofol, dexmedetomidine, fentanyl,
ketamine, lorazepam, midazolam, quetiapine, and haloperidol, some at high-dose infusions,
before his agitation and ventilator asynchrony could be controlled. His improvement
coincided with the addition of carisoprodol and phenobarbital to his treatment regimen.
Why Should an Emergency Physician Be Aware of This?
Trends show increasing emergency department presentations for drug-related disorders
and treatment. This case highlights an uncommon case of carisoprodol withdrawal that
may be encountered by emergency physicians, and demonstrates that benzodiazepines
may not be sufficient to suppress severe withdrawal symptoms. Treatment with carisoprodol and
phenobarbital provided additional benefit and can be considered in cases of severe
carisoprodol withdrawal.
Keywords
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Article info
Publication history
Published online: December 12, 2016
Accepted:
November 1,
2016
Received in revised form:
September 20,
2016
Received:
July 30,
2016
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
