Medication Summary
If placing a patient who has used lysergic acid diethylamide (LSD) in a quiet environment with minimal stimuli is not effective, a benzodiazepine (lorazepam or diazepam) is the medication of choice, especially in patients with dysphoric reactions. Benzodiazepines decrease central and peripheral sympathomimetic drug effects.
As previously mentioned, neuroleptic medications, such as haloperidol (Haldol), may have adverse psychomimetic effects and thus are not indicated in LSD intoxication.
Benzodiazepines
Class Summary
These agents may be indicated for an extremely agitated patient in order to control behavior and other autonomic signs and symptoms refractory to a quiet environment and verbal attempts to calm the patient’s behavior. Unlike antipsychotics, benzodiazepines do not lower the seizure threshold, a theoretical advantage in patients manifesting severe LSD toxicity. Sedation should be titrated carefully by the physician at the bedside.
Diazepam (Valium, Diastat)
This agent depresses all levels of the CNS (eg, limbic and reticular formation), possibly by increasing the activity of gamma-aminobutyric acid (GABA), a major inhibitory neurotransmitter in the brain. Although seizures may be promptly brought under control with diazepam, a significant proportion of patients experience a return to seizure activity, presumably because of the short-lived effect of the drug after intravenous administration.
Diazepam has been used successfully for decades to treat patients with signs and symptoms of severe LSD toxicity. However, no head-to-head study has compared the efficacy of diazepam with lorazepam in this setting, and both of these drugs are considered appropriate for such therapy.
Lorazepam (Ativan)
Lorazepam may depress all levels of the CNS (eg, limbic and reticular formation) by increasing the activity of GABA, a major inhibitory neurotransmitter in the brain. It is an effective alternative to diazepam for the treatment of patients with signs and symptoms of severe LSD toxicity.
Antihypertensives
Class Summary
The antihypertensive agent clonidine has been shown to attenuate some signs and symptoms of LSD toxicity.
Clonidine (Catapres, Nexiclon XR, Kapvay)
Clonidine has been found to decrease the severity of flashbacks and hallucinogen persisting perception disorder (HPPD) and to attenuate increased sympathetic activity associated with LSD use.
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Assorted lysergic acid diethylamide (LSD) blotter papers.
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Lysergic acid diethylamide (LSD) in assorted pill forms.
