Benzodiazepines

To the Editor: We were surprised to note that paradoxical effects of benzodiazepines are not mentioned by Greenblatt and colleagues (Aug. 11 and 18 issues).¹ These adverse reactions, including hyperactivity and irritability, were first described, for chlordiazepoxide, by Ingram and Timbury.² Since then, other paradoxical reactions, such as paradoxical excitement,³ hostile behavior,⁴ verbal and physical aggression,⁵ symptoms of delirium,⁶ rage reaction,⁷ increased anxiety or panic,⁸ and increased seizure frequency,³ have been reported. Several benzodiazepines, including chlordiazepoxide,² diazepam,³,⁶ clonazepam,³ triazolam,⁵ lorazepam,⁶ clorazepate,⁷ temazepam,⁸ and clobazam⁹ have been associated with such reactions. Unlike common side effects (drowsiness and ataxia), which are related.