Hyperventilation Syndrome Medication

  • Author: Brian Kern, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: Apr 20, 2012
 

Medication Summary

Benzodiazepines are effective in reducing stress that may provoke hyperventilation syndrome (HVS) and are thought to reset the central nervous system (CNS) response to a variety of “panicogens.” Selective serotonin reuptake inhibitors (SSRIs) have been reported to reduce the frequency and the severity of episodes of hyperventilation.

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Anxiolytics, Benzodiazepines

Class Summary

Benzodiazepines are useful in the treatment of hyperventilation resulting from anxiety and panic attacks. By binding to specific receptor sites, these agents appear to potentiate the effects of gamma-aminobutyric acid (GABA) and to facilitate inhibitory GABA neurotransmission and the actions of other inhibitory transmitters.

Alprazolam (Xanax, Niravam)

 

Alprazolam is indicated for treatment of anxiety and management of panic attacks.

Lorazepam (Ativan, Lorazepam Intensol)

 

Lorazepam is a sedative-hypnotic of the benzodiazepine class that has a short time to onset of effect and a relatively long half-life. By enhancing the action of GABA, a major inhibitory neurotransmitter, it may depress all levels of the CNS, including the limbic area and reticular formation.

Diazepam (Valium, Diastat)

 

Diazepam depresses all levels of the CNS (eg, limbic and reticular formation), possibly by increasing the activity of GABA. It is considered second-line therapy for seizures.

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Antidepressants, SSRIs

Class Summary

SSRIs are useful in treating hyperventilation associated with anxiety.

Paroxetine (Paxil, Pexeva)

 

Paroxetine is the alternative drug of choice for HVS. It is a potent selective inhibitor of neuronal reuptake of serotonin and has a weak effect on neuronal reuptake of norepinephrine and dopamine.

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Contributor Information and Disclosures
Author

Brian Kern, MD  Staff Physician, Department of Emergency Medicine, Detroit Medical Center; Clinical Assistant Professor, Wayne State University School of Medicine

Brian Kern, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Michigan College of Emergency Physicians, and Michigan State Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Adam J Rosh, MD  Assistant Professor, Department of Emergency Medicine, Detroit Receiving Hospital, Wayne State University School of Medicine

Adam J Rosh, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP  Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Paul Blackburn, DO, FACOEP, FACEP Attending Physician, Department of Emergency Medicine, Maricopa Medical Center

Paul Blackburn, DO, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Medical Association, and Arizona Medical Association

Disclosure: Nothing to disclose.

Robin R Hemphill, MD, MPH Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University School of Medicine

Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Edward J Newton, MD, FACEP, FRCPC Professor of Clinical Emergency Medicine, Chairman, Department of Emergency Medicine, University of Southern California Keck School of Medicine

Edward J Newton, MD, FACEP, FRCPC is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Royal College of Physicians and Surgeons of Canada, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References
  1. Shu BC, Chang YY, Lee FY, et al. Parental attachment, premorbid personality, and mental health in young males with hyperventilation syndrome. Psychiatry Res. Oct 31 2007;153(2):163-70. [Medline].

  2. Martinez JM, Kent JM, Coplan JD, et al. Respiratory variability in panic disorder. Depress Anxiety. 2001;14(4):232-7. [Medline].

  3. Bartley J. Nasal congestion and hyperventilation syndrome. Am J Rhinol. Nov-Dec 2005;19(6):607-11. [Medline].

  4. Castro PF, Larrain G, Perez O, et al. Chronic hyperventilation syndrome associated with syncope and coronary vasospasm. Am J Med. Jul 2000;109(1):78-80. [Medline].

  5. Ong JR, Hou SW, Shu HT, et al. Diagnostic pitfall: carbon monoxide poisoning mimicking hyperventilation syndrome. Am J Emerg Med. Nov 2005;23(7):903-4. [Medline].

  6. Malmberg LP, Tamminen K, Sovijarvi AR. Orthostatic increase of respiratory gas exchange in hyperventilation syndrome. Thorax. Apr 2000;55(4):295-301. [Medline].

  7. Gibson D, Bruton A, Lewith GT, et al. Effects of acupuncture as a treatment for hyperventilation syndrome: a pilot, randomized crossover trial. J Altern Complement Med. Jan-Feb 2007;13(1):39-46. [Medline].

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