Oxazepam Detected in Urine 79 Days After Withdrawal of Diazepam: A Case Report.

ABSTRACT: Patients suffering from substance use disorder, including for instance benzodiazepines, may have comorbidity with attention deficit hyperactivity disorder (ADHD). Centrally acting stimulants play an important role in the treatment of ADHD. Before such treatment can be initiated, withdrawal of benzodiazepines may be necessary. Urine testing is the preferred method for monitoring adherence in benzodiazepine withdrawal, but there is a lack of studies reporting detection time. Here, we report a case of a 30-year-old woman with substance use disorder and ADHD who had detectable metabolites of diazepam 79 days after withdrawal. To our knowledge, no cases with detection time equivalent to this have previously been published. This case report serves as an example that clinicians may need to consider interindividual pharmacokinetic characteristics when interpreting the results of urine drug tests, and that a positive urine test may still be consistent with abstinence from a certain drug. In the current case, a high body mass index and a genetic polymorphism gave a reasonable explanation for the prolonged detection of diazepam metabolites.

[Horse chestnut--remedy for chronic venous insufficiency]. / Hestekastanje - naturlegemiddel mot venøs insuffisiens.

Horse- chestnut seed extract is widely used throughout Europe, and has been used to treat a variety of medical conditions. The most common indication is currently chronic venous insufficiency, for which conventional therapy includes use of compression stockings. Horse chestnut seed extract is generally well tolerated; the most common side effects are gastrointestinal disturbances, dizziness and calf-muscle spasms. Clinical trials have shown that horse- chestnut seed extract and placebo are associated with similar side effects Horse- chestnut may interact with anticoagulants and antidiabetics, and caution is advised in patients taking these drugs. A number of clinical trials have shown that horse- chestnut seed extract may be beneficial to patients with mild to moderate chronic venous insufficiency. However, inadequate randomization, short duration and use of different end-points in these trials makes it difficult to conclude regarding effectiveness and safety, especially in long-term use. Horse- chestnut seed extract appears to be a short-term treatment option in patients with mild to moderate chronic venous insufficiency, but more rigorous trials are required to confirm the efficacy of this treatment.