Paradoxical drug reactions are an interesting concept, to say the least. Ordinarily, almost all illicit and prescription drugs will cause some type of reactions, even more so for the uninitiated who overindulge and head into the danger zone. At North Jersey Recovery Center, a big part of our job in helping patients is to see the kinds of reactions they are having to these drugs, including paradoxical ones. That way, we have a better gauge on how to tailor a treatment plan that is right for them. In today’s topic of discussion, let’s address the elephant in the room. What are paradoxical drug reactions?

Defining The Basics

A paradoxical drug reaction is when the opposite outcome of a drug occurs, rather than the expected outcome. It can be negative or positive. An example of a negative paradoxical drug reaction is taking a medication to reduce anxiety and the medication instead worsens your symptoms.

Which Types Of Medications Are Associated With Paradoxical Drug Reactions?

Paradoxical drug reactions can happen with many kinds of medications. Some of the most common types of medications associated with paradoxical drug reactions, include the following:

• Antidepressants
• Antipsychotics
• Anti-anxiety medication
• Sedatives, such as benzodiazepines
• Medications used to enhance or inhibit the body’s immune response

The Cause Of These Reactions

The exact cause of paradoxical drug reactions is not well known. However, some researchers believe that it happens when the dose of a certain medicine is too high or low, for that person. Additionally, genetics, drug tolerance, and any current infections may also play a huge role. Children and the elderly could be more prone to paradoxical drug reactions than other age groups.  

Clinical Features Of Paradoxical Reactions

Central features of paradoxical reactions (PRs) are emotional lability, agitation, excessive movement, and confusion. This could be associated with increased autonomic activity including tachycardia, hypertension, and tachypnea. Unfortunately, since there is no uniform definition of paradoxical drug reactions, the literature surrounding the subject is still very much in its infancy.

Paradoxical Reactions and Benzodiazepines

Benzodiazepines and propofol are frequently used in critical care. Both express similar mechanisms of action, based on activating inhibitory GABA receptors. Despite the fact that benzos can rarely trigger a paradoxical response, it’s still an important diagnosis to recognize, because more often than not, it could require specific management. The rate of PR’s following benzodiazepines use is probably around 1-2%, according to one study. Whereas, rates with propofol are higher.

Do These Reactions Occur In Critically Ill Patients?

From what we know on the habitual use of benzodiazepines and propofol amongst critically ill patients, PR’s would be expected to persist with some regularity. However, the medical literature fails to address this. Why? It could be due to the difficulties of diagnosing a PR in the ICU. They are largely part of a diagnosis of exclusion, which could be arduous in a complicated patient case. Agitation seems to be the most common symptom for ICU patients. Even if this is to be regarded as factual, the fact there is confluence with other symptoms from other ailments, makes the job for medical staff harder, but not impossible. 

Neurobiology Of Paradoxical Reactions

On this subject, matters continue to be unclear. Certain idiosyncratic reactions could be contingent on genetic variability. Notably, one report documented a pair of identical twins who both had dramatic reactions to midazolam. The increased rate of paradoxical drug reactions in alcoholism might relate to changes in GABA receptors and GABAergic pathways that are induced by alcoholism.

Approach For Managing Reactions

The management of paradoxical reactions should include the following, core elements:

• Stop the offending agent

• Counteract residual drug (Flumazenil)

• Add a non-GABA sedating medication

Paradoxical Reaction Examples

Two of the most reported examples of paradoxical reactions involve benzodiazepines and stimulants.

Benzodiazepines can trigger the following reactions in patients:

• Excitement
• Emotional Release
• Excessive Movement
• More talkative
• Impulse Control
• Anxiety
• Aggression
• Disinhibition
• Confusion
• Agitation
• Talkativeness
• Violence

Stimulant Reactions That Are Paradoxical:

Amphetamines belong to a class of psychoactive drugs classified as stimulants. Paradoxical reactions infrequently occur in adults using stimulants in the form of paradoxical drowsiness. Stimulant medications like Ritalin and Adderall have a paradoxical effect on both children and adults with ADHD. The issues can include issues with sleeping manifest, despite the increase in focusing.

Getting Help For Paradoxical Drug Reactions: North Jersey Recovery Center

Drug and alcohol addiction can be a difficult problem to overcome on your own. If you’re struggling with addiction and are looking for help, there are many resources available from our medical professionals with North Jersey Recovery Center. There is no shame in seeking assistance; in fact, it takes courage to admit that you need help and seek out treatment. If you or someone you know is battling drug or alcohol addiction, please don’t hesitate to reach out for help. The staff at our treatment center is here to support you every step of the way on your road to recovery.