Un colpo al cerchio ed un colpo alla botte: il ruolo del flumazenil nelle disintossicazioni miste alcol-benzodiazepine.

Benzodiazepine (BZD) are the therapeutic tool of choice in the treatment of alcohol and Gamma Hydroxybutyrate (GHB) dependence even if BZD can cause tolerance and drug dependence themselves . The BZD, alcohol and GHB withdrawal symptoms have many traits in common and they can be both severe1. Occasionally, chronic use of BZD can reach the size of a real abuse2,3; this situation, when in comorbidity with a severe alcohol or GHB dependence, poses some problems in the clinical management of detoxification for the cross-tolerance phenomenon. This can entails a longer hospitalization and increased costs. It is little known and even less applied the technique of BZD detoxification by using the flumazenil slow infusion (FLU-SI), although the first clinical trial dates back to 20 years ago4. Flumazenil allows rapid detoxification because, when infused slowly, it acts as a partial agonist and it quickly normalizes the uncoupling of GABA-A receptors caused by BZD abuse 4-6. We present 2 case reports: a fast detoxification from a combined abuse of alcohol and very high-dose of BZD, and a fast detoxification from a combined abuse of GHB and BZD dependence by using FLU-SI