Benzodiazepines and Thermal Dysregulation
Yes, benzodiazepines can cause thermal dysregulation, particularly hypothermia, through their effects on the central nervous system's thermoregulatory mechanisms. 1, 2
Mechanisms of Benzodiazepine-Induced Thermal Dysregulation
- Benzodiazepines can impair body heat balance through both central action on the thermoregulatory controller in the hypothalamus and peripheral action on blood vessels 2
- Full benzodiazepine receptor agonists (like loprazolam) have been shown to produce hypothermia in experimental studies, with maximal effects seen at relatively low doses 1
- The preoptic region in the ventral hypothalamus acts as a coordinating center for thermoregulation, and benzodiazepines may interfere with this process 3
Risk Factors for Thermal Dysregulation with Benzodiazepines
- Advanced age or frailty increases sensitivity to benzodiazepine effects, including thermal dysregulation 4
- The risk of temperature dysregulation appears higher in the first days after initiation of therapy or after increases in daily dose 3
- Concurrent use of other central nervous system depressants (e.g., opioids, muscle relaxants, hypnotics) can potentiate adverse effects of benzodiazepines 5
Clinical Manifestations and Management
- Benzodiazepines can cause hypothermia that may require external rewarming interventions 2
- Temperature dysregulation can manifest as part of benzodiazepine-induced sedation and central nervous system depression 5
- Monitoring body temperature is particularly important during the initial phases of benzodiazepine treatment 4
- In post-cardiac arrest care, benzodiazepines may contribute to temperature management challenges, as they can affect thermoregulation 5
Special Considerations
- Benzodiazepines may cause paradoxical reactions in some patients, including agitation and delirium, which could indirectly affect temperature regulation 4
- Long-acting benzodiazepines may contribute to delayed awakening and accumulation due to reduced metabolism during hypothermia 5
- Environmental factors (such as ambient temperature) can interact with benzodiazepine effects on thermoregulation 2, 6
- Benzodiazepines can inhibit shivering, which is an important thermoregulatory mechanism, potentially contributing to hypothermia 5
Prevention and Monitoring
- Lower doses of benzodiazepines should be used in older or frail patients to minimize risk of thermal dysregulation 4
- Careful monitoring of body temperature is warranted when initiating benzodiazepine therapy, particularly in vulnerable populations 3
- Clinicians should be aware of the potential for benzodiazepines to cause temperature dysregulation when used in combination with other medications that affect thermoregulation 6