Heading to Hospital? Informed Consent & Navigating Inpatient Care 

Entering a hospital when you are experiencing prescription drug withdrawal, kindling, or central nervous system (CNS) instability can feel overwhelming. Hospital environments are fast-paced, and standard clinical protocols do not always account for the unique vulnerabilities of an injured or hypersensitive nervous system.

This guide is designed to help you, your family, or your advocate prepare for a hospital admission or Emergency Department visit, highlight hidden risks, and empower you to self-advocate safely.

Hidden Risks to Watch For in the Hospital

When your nervous system is in a state of hyper-reactivity due to withdrawal or kindling, routine medical interventions can potentially inadvertently trigger set-backs or exacerbations.

Routine Perioperative Antiemetics (Anti-Nausea Drugs)

The Risk: During surgery or under general anesthesia, anti-nausea medications are routinely administered via IV to prevent post-operative vomiting.¹

Why it's Problematic: Common hospital antiemetics - such as metoclopramide (Reglan), droperidol (Inapsine), prochlorperazine (Compazine), and promethazine (Phenergan) - have dopamine-antagonist properties and can cause extrapyramidal adverse effects including akathisia (a severe state of motor restlessness and inner terror) and acute dystonia.²

Self-Advocacy Tip: Explicitly inform your anesthesiologist and surgical team before any procedure that you have a sensitised nervous system/akathisia risk, and ask them to avoid dopamine-blocking antiemetics in favor of non-dopaminergic alternatives (e.g., 5-HT3 antagonists like ondansetron or steroids like dexamethasone, where clinically appropriate).¹ Scroll to the bottom to find a list of medications that may cause or worsen akathisia. 

Rapid Drug Substitutions or Abrupt Medication Changes

The Risk: Hospital pharmacies stock specific generic brands and standard formulations. If you are admitted, medical staff may substitute your regular prescription with a different generic manufacturer, or alter your formulation (e.g., swapping a liquid suspension for a dry compressed tablet).

Why it's Problematic: For a highly sensitised nervous system, subtle differences in binding agents, excipients, or the altered bio-availability between liquid and dry formulations may feel like an abrupt dose change, triggering withdrawal spikes or nervous system instability.³

Self-Advocacy Tip: Bring an up-to-date medication list and, where permitted, your medication in its original labelled packaging. If maintaining a particular manufacturer or formulation is important because of previous reactions or a precise taper, tell the medical, nursing and pharmacy teams and ask that this is documented.

 Multiple New Medications & Polydrugging

The Risk: During a hospital admission, additional medications may be introduced to manage individual symptoms such as insomnia, anxiety, agitation, nausea, or pain. When several medicines are added within a short period, it can become difficult to distinguish the underlying illness from withdrawal symptoms, adverse drug reactions, and drug–drug interactions.⁴

Why it Matters: Polypharmacy can increase the risk of adverse drug events and clinically significant interactions, particularly when several central nervous system (CNS)-acting medicines are used together.⁵ Introducing multiple drugs at once can also make it harder to identify which medication is responsible if new symptoms develop.

Self-Advocacy Tip: Keep an up-to-date list of everything you take, including supplements and over-the-counter medicines. Before a new medication is introduced, ask why it is needed, whether it could interact with your existing medication, whether a non-drug approach is appropriate, and how long it is intended to be used for. If several new medications are proposed, you can ask whether each is necessary and request a pharmacist or medication review where appropriate.

Enforced Fasting and Dehydration

Fasting and changes in normal fluid or food intake can be physically stressful, particularly for patients who already experience autonomic symptoms. Hypoglycaemia, when it occurs, can itself cause autonomic symptoms including palpitations, tremor, sweating and anxiety.⁶

Self-Advocacy Tip: If fasting is particularly difficult for you, or you have conditions affecting hydration, blood glucose or autonomic function, tell the clinical team. Ask what fluids are permitted and whether IV fluids are clinically appropriate during prolonged fasting.

Flumazenil and Rapid Detox Protocols

If you are physically dependent on benzodiazepines, make sure this is clearly communicated to hospital staff. Flumazenil is a benzodiazepine receptor antagonist used in certain circumstances to reverse benzodiazepine effects. In physically dependent patients, it can precipitate acute withdrawal and withdrawal seizures and therefore requires particular caution.⁷

NICE advises that benzodiazepines and other dependence-forming medicines should generally not be stopped abruptly. Withdrawal should ordinarily involve an individualised, slow, stepwise reduction, with the rate adjusted according to the person's response.⁸

Checklist for your Hospital Visit

1. Prepare an Emergency Medical Info Sheet

Print a one-page document detailing your current taper schedule, known drug sensitivities, severe reactions (e.g., "History of Akathisia / CNS Hypersensitivity"), and your emergency contact/advocate's details.

2. Bring Your Own Medication 

Keep your exact brands, dry/liquid formulations, and compounding supplies with you in their original pharmacy-labeled containers.

3. Appoint an Advocate

 If possible, have a trusted family member or friend stay with you to speak up on your behalf if you become incapacitated, or overwhelmed. 

4. Speak to the Anesthesiologist Early

 If undergoing surgery, request to speak with the anesthesia team prior to the operation to explicitly review your perioperative drug plan and antiemetic preferences.

5. Request "Slow Taper / No Abrupt Changes" on Your Chart

 Ask the attending physician to make a note in your inpatient chart stating that your psychiatric or neurological medications are not to be held, rapidly reduced, or switched without consulting your primary prescriber or taper plan.

High-Risk Drugs That May Induce or Worsen Akathisia

If you are prone to or currently experiencing akathisia, many commonly used hospital medications can worsen your symptoms. Keep a list of these medications with you or share them with your care team.

Via The Akathisia Alliance.org:

"The medications that most commonly cause or exacerbate akathisia are listed below, including all antipsychotics and antiemetics that deplete dopamine as well as most classes of antidepressants as they can indirectly do this as well.⁹˒¹⁰ Although low-dose mirtazapine is often listed as a potential treatment for akathisia, it is included because there are several published cases of mirtazapine-induced akathisia.¹¹ As there are published cases of akathisia induced by calcium channel blockers,¹² certain antibiotics,¹³–¹⁵ lithium,¹⁶ gabapentin,¹⁷ and pregabalin,¹⁸ they are also included."¹⁹