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===Antipsychotics===
[[Chlorpromazine]], an [[antipsychotic]] and [[antiemetic]] drug which is classed as a "major" [[tranquilizer]], may cause paradoxical effects such as agitation, hallucinations, excitement, insomnia, bizarre dreams, aggravation of psychotic symptoms and toxic confusional states.<ref>[
These may be more common in elderly dementia patients.
===Barbiturates===
[[Phenobarbital]] can cause hyperactivity in children. This may follow after a small dose of 20 mg, on condition of no phenobarbital administered in previous days.<ref>{{cite web | title = Professional Health Care Providers | url = http://professionals.epilepsy.com/medications/p_phenobarbital_commonside.html | work = Epilepsy Foundation }}</ref>
[[Barbiturate]]s such as [[pentobarbital]] have been shown to cause paradoxical hyperactivity in an estimated 1% of children, who display symptoms similar to the hyperactive-impulsive subtype of [[attention deficit hyperactivity disorder]]. Intravenous [[caffeine]] administration can return these patients'
===Benzodiazepines===
[[Benzodiazepine]]s, a class of psychoactive drugs called the "minor" [[tranquilizer]]s, have varying [[hypnotic]], [[sedative]], [[anxiolytic]], [[anticonvulsant]], and [[muscle relaxant|muscle relaxing]] properties, but they may create the exact opposite effects. Susceptible individuals may respond to benzodiazepine treatment with an increase in [[anxiety]], [[aggressiveness]], [[psychomotor agitation|agitation]], [[confusion]], [[paradoxical disinhibition|disinhibition]], loss of [[impulse control]], [[talkativeness]], [[violent]] behavior, and even [[convulsions]]. Paradoxical adverse effects may even lead to [[criminal
Paradoxical rage reactions due to benzodiazepines occur as a result of an altered level of consciousness, which generates [[automatic behaviors]], [[anterograde amnesia]] and uninhibited aggression. These aggressive reactions may be caused by a disinhibiting [[Serotonin|serotonergic]] mechanism.<ref>{{cite journal | vauthors = Senninger JL, Laxenaire M | title = [Violent paradoxal reactions secondary to the use of benzodiazepines] | language = fr | journal = Annales médico-psychologiques | volume = 153 | issue = 4 | pages = 278–81; discussion 281–2 | date = April 1995 | pmid = 7618826 | trans-title = Violent paradoxical reactions secondary to the use of benzodiazepines }}</ref>
Paradoxical effects of benzodiazepines appear to be dose
In a letter to the ''[[British Medical Journal]]'', it was reported that a high proportion of parents referred for actual or threatened [[child abuse]] were taking medication at the time, often a combination of [[benzodiazepines]] and [[tricyclic antidepressants]]. Many mothers described that instead of feeling less anxious or depressed, they became more hostile and openly aggressive towards the child as well as to other family members while consuming tranquilizers. The author warned that environmental or social stresses such as difficulty coping with a crying baby combined with the effects of tranquilizers may precipitate a child abuse event.<ref>{{cite journal | vauthors = | title = Letter: Tranquilizers causing aggression | journal = British Medical Journal | volume = 1 | issue = 5952 | pages = 266 | date = February 1975 | pmid = 234269 | pmc = 1672080 | doi = 10.1136/bmj.1.5952.266 }}</ref>
[[Self-harm|Self
Benzodiazepines can sometimes cause a paradoxical worsening of [[EEG]] readings in patients with seizure disorders.<ref>{{cite journal | vauthors = Perlwitz R, Grimmberger E, Schmidtsdorf R | title = [Immediate effect of intravenous clonazepam on the EEG] | journal = Psychiatrie, Neurologie, und Medizinische Psychologie | volume = 32 | issue = 6 | pages = 338–44 | date = June 1980 | pmid = 7403357 }}</ref>
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=== Naltrexone ===
[[Naltrexone]] blocks the opioid receptors, acting opposite to most opioid pain medications.<ref>{{Citation |last=Wright |first=Tricia E. |title=Pharmacotherapy for Opioid Use Disorders in Special Populations |date=September 2020 |url=http://dx.doi.org/10.1093/med/9780190920197.003.0011 |work=Substance Use Disorders |pages=185–202 |publisher=Oxford University Press |doi=10.1093/med/9780190920197.003.0011 |isbn=978-0-19-092019-7 |access-date=2023-01-15}}</ref> It can be used to negate the effects of opioid painkillers. At doses around one-tenth of the typical dose, naltrexone has been used for pain relief. [[Low-dose naltrexone]] is believed to have an anti-inflammatory effect. This is an off
===Diphenhydramine===
[[Diphenhydramine]] (often referred to by the trade name [[Benadryl]]) is an [[anticholinergic]] [[antihistamine]] medicine commonly used to treat allergic reactions and symptoms of a [[common cold]], such as [[cough]]ing. Its central antihistaminergic properties also cause it to act as a [[sedative]], and for this reason it is also used to treat [[insomnia]].<ref>{{Cite web |date=2018-09-21 |title=Diphenhydramine: drowsy (sedating) antihistamine |url=https://www.nhs.uk/medicines/diphenhydramine/ |access-date=2024-01-11 |website=nhs.uk |language=en}}</ref> Diphenhydramine is also used off-label for its sedative properties, particularly by parents seeking to make their children sedated or sleep during [[long-haul flight]]s. This use of diphenhydramine has been
==Causes==
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The mechanism of a paradoxical reaction has as yet (2019) not been fully clarified, in no small part due to the fact that signal transfer of single [[neuron]]s in [[subcortical]] areas of the human brain is usually not accessible.{{citation needed|date=June 2024}}
There are, however, multiple indications that paradoxical reactions upon – for example – benzodiazepines, barbiturates, [[inhalational anesthetic]]s, [[propofol]], [[neurosteroid]]s, and [[Alcohol (drug)|alcohol]] are associated with structural deviations of [[GABAA receptor|GABA<sub>A</sub> receptor]]s. The combination of the five subunits of the receptor (see image) can be altered in such a way that for example, the receptor's response to GABA remains unchanged but the response to one of the named substances is dramatically different from the normal one.{{citation needed|date=June 2024}}
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