Nitrazepam-induced cricopharyngeal dysphagia, abnormal esophageal peristalsis and associated bronchospasm: probable cause of nitrazepam-related sudden death.

Nitrazepam was used in the treatment of resistant myoclonic epilepsy in 38 children. After the occurrence of nitrazepam-associated swallowing incoordination, high-peaked esophageal peristalsis and related bronchospasm in one patient, we initiated a prospective study of esophageal manometry using a station pull-through technique with a pediatric 4-channel continuous perfusing system. Three more patients were found to have delayed cricopharyngeal relaxation and high-peaked esophageal peristaltic waves. The initial patient developed severe respiratory distress and bronchospasm necessitating ventilatory support while on nitrazepam and improved dramatically with subsequent normal manometric study following nitrazepam discontinuation. Nitrazepam was reintroduced for its anticonvulsant and cognitive benefits and was tolerated at a reduced dosage. We postulate a central nervous system effect of nitrazepam promoting parasympathetic overactivity or vagotonia which can cause potentially fatal respiratory distress. Care must be exercised in nitrazepam use and esophageal manometry may be helpful in defining patients at greater risk for sudden death.
AuthorsH C Lim, M A Nigro, P Beierwaltes, V Tolia, R Wishnow
JournalBrain & development (Brain Dev) Vol. 14 Issue 5 Pg. 309-14 (Sep 1992) ISSN: 0387-7604 [Print] JAPAN
PMID1456385 (Publication Type: Case Reports, Journal Article, Review)
Chemical References
  • Nitrazepam
  • Adolescent
  • Bronchial Spasm (chemically induced)
  • Child
  • Child, Preschool
  • Cricoid Cartilage (drug effects)
  • Death, Sudden (etiology)
  • Deglutition Disorders (chemically induced)
  • Dose-Response Relationship, Drug
  • Epilepsies, Myoclonic (drug therapy)
  • Esophagus (drug effects, physiopathology)
  • Female
  • Humans
  • Infant
  • Male
  • Manometry
  • Multivariate Analysis
  • Nitrazepam (administration & dosage, adverse effects, therapeutic use)
  • Peristalsis (drug effects)
  • Pharynx (drug effects)

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research network!

Choose Username:
Verify Password: