Clinical Practice of Treating Benzodiazepine Poisoning with Kahwa (Black Tea) in Acute Cases of Overdose: Benzodiazepine Poisoning with Kahwa (Black Tea) in Acute Cases of Overdose

Javeria Khan; Muhammad Inam Khan; Muhammad Ashar Khan; Omer Sultan; Amnah Khan; Desaar Zahra

doi:10.54393/pjhs.v7i1.3481

Authors

Javeria Khan Department of General Surgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan
Muhammad Inam Khan 2Department of Internal Medicine, Jinnah Postgraduate Medical Center, Karachi, Pakistan
Muhammad Ashar Khan Department of Pathology, Liaquat College of Medicine and Dentistry, Karachi, Pakistan
Omer Sultan 2Department of Internal Medicine, Jinnah Postgraduate Medical Center, Karachi, Pakistan
Amnah Khan Karachi Medical and Dental College, Karachi, Pakistan
Desaar Zahra 2Department of Internal Medicine, Jinnah Postgraduate Medical Center, Karachi, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v7i1.3481

Keywords:

Altered Consciousness, Benzodiazepine, Flumazenil, Intubation, Kahwa

Abstract

Recently, an increasing trend of using black tea (Kahwa) in many diseases has been noticed due to its numerous health benefits with less to no side effects and easy availability. Objectives: To describe the clinical characteristics, management practices, and short-term outcomes of patients with acute benzodiazepine overdose who received Kahwa as part of supportive care. Methods: This retrospective descriptive study was conducted at the National Poison Control Center, Jinnah Postgraduate Medical Center, Karachi. Patients aged 13–70 years with confirmed acute benzodiazepine overdose were included using a non-probability consecutive sampling technique. All patients received standard supportive care plus enteral feeding of Kahwa via nasogastric tube (NG). Data were analyzed using IBM-SPSS version 26.0, and significance was set at p<0.05. Results: A total of 200 patients with acute benzodiazepine overdose were analyzed. There were 50.5% patients who were male, with an overall median age of 24 years (IQR: 20–38). In most cases, 75.5% presented within two hours of ingestion, and 81.5% had taken ten or fewer tablets. Hypertension and diabetes were present in 4.5% and 4.0% of patients, respectively. The most common presenting features were altered consciousness (25.0%) and non-reactive pupils (27.5%). Intubation was required in 2 patients (1.0%), and flumazenil was given to 3 (1.5%). Conclusions: This study documents current clinical practice in managing benzodiazepine overdose, including adjunctive Kahwa administration. The results are descriptive and do not indicate the therapeutic effect of Kahwa specifically, as no causal interpretation is possible.

References

Liu S. Trends in Nonfatal and Fatal Overdoses Involving Benzodiazepines—38 States and the District of Columbia, 2019–2020. Morbidity and Mortality Weekly Report. 2021 Aug; 70(34): 1136–1141. doi: 10.15585/mmwr.mm7034a2. DOI: https://doi.org/10.15585/mmwr.mm7034a2

Marie BJ, Witry MJ, Reist JC. Barriers to Increasing Prescription Drug Monitoring Program Use: A Multidisciplinary Perspective. Computers, Informatics, Nursing. 2023 Aug; 41(8): 556-62. doi: 10.1097/CIN.0000000000000997. DOI: https://doi.org/10.1097/CIN.0000000000000997

Sharbaf SN, Bistas KG, Patel P, Saadabadi A. Flumazenil. 2024 Feb. In: Stat Pearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2025 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470180.

Xiao X, Erukainure OL, Sanni O, Koorbanally NA, Islam MS. Phytochemical Properties of Black Tea (Camellia sinensis) and Rooibos Tea (Aspalathus linearis); and Their Modulatory Effects on Key Hyperglycaemic Processes and Oxidative Stress. Journal of Food Science and Technology. 2020 Dec; 57(12): 4345-54. doi: 10.1007/s13197-020-04471-w. DOI: https://doi.org/10.1007/s13197-020-04471-w

Pan H, Le M, He C, Yang CS, Ling T. Dark Tea: A Popular Beverage with Possible Medicinal Application. Chinese Herbal Medicines. 2023 Jan; 15(1): 33-6. doi: 10.1016/j.chmed.2022.08.005. DOI: https://doi.org/10.1016/j.chmed.2022.08.005

Naveed M, Bibi J, Kamboh AA, Suheryani I, Kakar I, Fazlani SA et al. Pharmacological Values and Therapeutic Properties of Black Tea (Camellia Sinensis): A Comprehensive Overview. Biomedicine and Pharmacotherapy. 2018 Apr; 100: 521-31. doi: 10.1016/j.biopha.2018.02.048. DOI: https://doi.org/10.1016/j.biopha.2018.02.048

Aaqil M, Peng C, Kamal A, Nawaz T, Zhang F, Gong J. Tea Harvesting and Processing Techniques and Their Effect on Phytochemical Profile and Final Quality of Black Tea: A Review. Foods. 2023 Dec; 12(24): 4467. doi: 10.3390/foods12244467. DOI: https://doi.org/10.3390/foods12244467

Ismail A, Akhtar S, Riaz M, Gong YY, Routledge MN, Naeem I. Prevalence and Exposure Assessment of Aflatoxins Through Black Tea Consumption in the Multan City of Pakistan and the Impact of Tea Making Process on Aflatoxins. Frontiers in Microbiology. 2020 Mar; 11: 446. doi: 10.3389/fmicb.2020.00446. DOI: https://doi.org/10.3389/fmicb.2020.00446

Aydemir ME, Takım K, Yılmaz MA. Characterization of Phenolic Components of Black Teas of Different Origins and the Effect of Brewing Duration on Quality Properties. Food Science and Nutrition. 2024 Jan; 12(1): 494-507. doi: 10.1002/fsn3.3782. DOI: https://doi.org/10.1002/fsn3.3782

Truong VL and Jeong WS. Cellular Defensive Mechanisms of Tea Polyphenols: Structure-Activity Relationship. International Journal of Molecular Sciences. 2021 Aug; 22(17): 9109. doi: 10.3390/ijms22179109. DOI: https://doi.org/10.3390/ijms22179109

Wnuk E. The Antioxidant Potential of Black Tea Polyphenols in Heavy Metal Toxicity: An In Vitro Perspective. International Journal of Molecular Sciences. 2025 Aug; 26(16): 7926. doi: 10.3390/ijms26167926. DOI: https://doi.org/10.3390/ijms26167926

Deo AS, Devi PA, Sijisha KS, Anusha R, Mishra T, Mathew S et al. Comparative Studies on the Antioxidant, Anticancer and Anti-Inflammatory Activities of Green Tea, Orthodox Black Tea and CTC Black Tea. Journal of Food Science and Technology. 2024 Jul; 61(7): 1315-25. doi: 10.1007/s13197-023-05900-2. DOI: https://doi.org/10.1007/s13197-023-05900-2

Teasdale G, Knill-Jones RO, van der Sande JA. Observer Variability in Assessing Impaired Consciousness and Coma. Journal of Neurology, Neurosurgery and Psychiatry. 1978 Jul; 41(7): 603-10. doi: 10.1136/jnnp.41.7.603. DOI: https://doi.org/10.1136/jnnp.41.7.603

Shannon E, Jaiswal AK, Abu-Ghannam N. Polyphenolic Content and Antioxidant Capacity of White, Green, Black, and Herbal Teas: A Kinetic Study. Food Research. 2017; 2(1): 1-11. doi: 10.26656/fr.2017.2(1).117. DOI: https://doi.org/10.26656/fr.2017.2(1).117

Association of Poisons Centres and Clinical Toxicology E. Position Paper: Single-Dose Activated Charcoal. Clinical Toxicology. 2005; 43(2): 61-88. doi: 10.1081/CLT-51867. DOI: https://doi.org/10.1081/CLT-51867

An H and Godwin J. Flumazenil in Benzodiazepine Overdose. Canadian Medical Association Journal. 2016 Dec; 188(17-18): E537-. doi: 10.1503/cmaj.160357. DOI: https://doi.org/10.1503/cmaj.160357

Weinbroum A, Rudick V, Sorkine P, Nevo Y, Halpern P, Geller E et al. Use of Flumazenil in the Treatment of Drug Overdose: A Double-Blind and Open Clinical Study in 110 Patients. Critical Care Medicine. 1996 Feb; 24(2): 199-206. doi: 10.1097/00003246-199602000-00004. DOI: https://doi.org/10.1097/00003246-199602000-00004

Saleem U, Mahmood S, Ahmad B, Erum A, Azhar S, Ahmad B. Benzodiazepine Poisoning Cases: A Retrospective Study from Faisalabad, Pakistan. Pakistan Journal of Pharmacology. 2010; 23(1): 11-3.

Giftson J, Hazra D, Chandy GM. A Two-Year Retrospective Observational Cohort Study of Benzodiazepine Overdose Cases in the Emergency Department. Indian Journal of Critical Care Medicine: Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine. 2025 Feb; 29(3): 230. doi: 10.5005/jp-journals-10071-24925. DOI: https://doi.org/10.5005/jp-journals-10071-24925

Carry E, Vasilatis A, Johnson AL, Ryan JW. Expecting Medication Misuse: A Proactive Approach to Drug Discovery to Prevent Fatal Overdose. Future Medicinal Chemistry. 2025 Mar; 17(6): 681-92. doi: 10.1080/17568919.2025.2476388. DOI: https://doi.org/10.1080/17568919.2025.2476388

Bano S, Majumder A, Srivastava A, Nayak KB. Deciphering the Potentials of Cardamom in Cancer Prevention and Therapy: From Kitchen to Clinic. Biomolecules. 2024 Sep; 14(9): 1166. doi: 10.3390/biom14091166. DOI: https://doi.org/10.3390/biom14091166

Reichert CF, Deboer T, Landolt HP. Adenosine, Caffeine, and Sleep–Wake Regulation: State of the Science and Perspectives. Journal of Sleep Research. 2022 Aug; 31(4): e13597. doi: 10.1111/jsr.13597. DOI: https://doi.org/10.1111/jsr.13597

Hladun O, Papaseit E, Martín S, Barriocanal AM, Poyatos L, Farré M et al. Interaction of Energy Drinks with Prescription Medication and Drugs of Abuse. Pharmaceutics. 2021 Sep; 13(10): 1532. doi: 10.3390/pharmaceutics13101532. DOI: https://doi.org/10.3390/pharmaceutics13101532

Wasowski C, Marder M. Flavonoids as GABAA Receptor Ligands: The Whole Story? Journal of Experimental Pharmacology. 2012 Feb: 9-24. doi: 10.2147/JEP.S23105. DOI: https://doi.org/10.2147/JEP.S23105

Farn SS, Cheng KH, Huang YR, Lee SY, Chen JT, Chang KW. Automated Synthesis of [18F] Flumazenil Application in GABAA Receptor Neuroimaging Availability for Rat Model of Anxiety. Pharmaceuticals. 2023 Mar; 16(3): 417. doi: 10.3390/ph16030417. DOI: https://doi.org/10.3390/ph16030417

Elgarf AA, Siebert DC, Steudle F, Draxler A, Li G, Huang S et al. Different Benzodiazepines Bind with Distinct Binding Modes to GABAA Receptors. American Chemical Society Chemical Biology. 2018 May; 13(8): 2033-9. doi: 10.1021/acschembio.8b00144. DOI: https://doi.org/10.1021/acschembio.8b00144

Hassen G, Belete G, Carrera KG, Iriowen RO, Araya H, Alemu T et al. Clinical Implications of Herbal Supplements in Conventional Medical Practice: A US Perspective. Cureus. 2022 Jul; 14(7): e26893. doi: 10.7759/cureus.26893. DOI: https://doi.org/10.7759/cureus.26893