A cardiac case included long-term alprazolam exposure but identified a recent AV-nodal blocker as the more likely precipitating factor.
A seventy-three-year-old woman presented with severe bradycardia, renal impairment, hyperkalemia and shock-related features. She had long-term alprazolam use and recent bisoprolol treatment. Heart rate and renal function improved during treatment of the combined physiological disturbance. The authors described any modulatory alprazolam role as speculative.
One patient cannot establish an interaction mechanism or a causal alprazolam association. Electrolytes, kidney dysfunction and AV-nodal blockade provide major competing explanations. Temporal presence of a long-standing medicine differs from evidence that it initiated the acute deterioration.
For a cardiac toxicology opinion, prioritize the actual timeline, laboratory abnormalities and response to correction. Do not turn a drug mentioned in the title or medication list into a proven cause. This case is useful for explaining how a multi-factor syndrome can be misattributed to a familiar sedative.
Source reviewed: BRASH syndrome in a patient with coexisting anxiety disorder and long term benzodiazepine use A case (PMC13070232). Forensic implications are interpretive analysis of the supplied paper.
Related reading: Remimazolam Cardiac Experiments Found Late Repolarization Changes Without QT Prolongation.