Bovine-Derived Adrenal Cortex Supplement Self-Medication for Benzodiazepine Withdrawal

Adrenal cortex supplements are commonly marketed for fatigue, stress, and nonspecific somatic complaints, often promoted for “adrenal fatigue.” The condition is not recognized in formal medical diagnosis or the nosological system. Despite limited evidence supporting their efficacy, these products remain widely available without prescription.¹ In the International Classification of Diseases, Tenth Revision,² misuse of hormone and related products is listed as abuse of non–dependence-producing substances (F55) when used in maladaptive patterns. Adrenal supplements frequently contain bovine adrenal extracts marketed as glandular support products. Analyses of commercially available adrenal supplements have detected biologically active thyroid and steroid hormones in some preparations, sometimes without disclosure on product labels.³ Exposure to exogenous glucocorticoids can influence the hypothalamic-pituitary-adrenal axis and produce neuropsychiatric effects including anxiety, insomnia, and mood disturbances.⁴ A recent position statement from the American Association of Clinical Endocrinology (AACE) has raised concern for risk and cost of growing misuse of adrenal supplements.⁵ The misuse has been observed mostly due to direct-to-consumer advertising and false claims to prevent aging or to improve men’s health.

We report a case of an individual who regularly used a bovine-derived adrenal cortex supplement during benzodiazepine (BZD) withdrawal. A preliminary search through April 2026 in PubMed using the keywords “supplement”/“adrenal supplement” AND “self-medication” AND “substance”/”benzodiazepine” AND “withdrawal” did not reveal a similar report.

Case Report

A 31-year-old man presented to the outpatient department at a psychiatric hospital in India with a chronic history of polysubstance use. He reported regular tobacco use for 14 years and cannabis use for the same duration. He started alcohol consumption 7 years ago, with occasional binge episodes. For 5 years, he had been using BZDs in a dependent pattern, consuming high doses of different BZDs depending on availability. Among BZDs, he used to take oral lorazepam 1 mg up to 30–40 tablets/day, nitrazepam 10 mg up to 40 tablets/day, or clonazepam 0.5 mg up to 40–50 tablets/day. He described dose escalation and had experienced severe withdrawal symptoms whenever he reduced or stopped using BZDs. Though not permitted, he admitted that he kept procuring BZDs without a valid prescription from shops.

During the COVID-19 pandemic, when he could not obtain over-the-counter (OTC) BZDs, he was told about a product sold as “Adrenal.” The shopkeeper suggested that use of this product would alleviate the discomfort from symptoms he was experiencing after stopping BZD use. According to the product label, each serving (2 capsules) contained whole bovine adrenal extract 300 mg and bovine adrenal cortex extract 160 mg, with each bottle containing 60 capsules (30 servings). The package also mentions vegetarian capsules (cellulose, water) as other ingredients. He had been using the product for about 1 year before he sought treatment at our center. Initially, he consumed 5–10 capsules during withdrawal episodes to relieve fatigue and anxiety. Over time, the pattern escalated to 10–15 capsules per episode, increasing to up to 20 capsules when BZDs were unavailable. He reported subjective improvement in fatigue and mild reduction in anxiety within about 30–60 minutes of ingestion. Because of these benefits, he continued intermittent use during withdrawal periods. He never reported use of “Adrenal” at any other time. The supplement was obtained through both the supplier network and local pharmacies. He did not report craving or withdrawal symptoms when he stopped using the product. The physical examination revealed pallor, bilateral tremors, and hesitation cuts on the forearms. The Clinical Institute Withdrawal Assessment for Benzodiazepines⁶ score was 37, indicating severe withdrawal. He was treated as an inpatient. Detoxification was completed with intravenous lorazepam, which was cross-tapered to oral BZD. Sodium valproate (increased to 1,200 mg/day) and naltrexone (50 mg/day) were initiated for impulsivity and craving, respectively. Motivational enhancement therapy was offered.

Discussion

This case demonstrates substitutional use of an adrenal cortex supplement in BZD withdrawal. Pharmacologic management of BZD withdrawal is challenging.⁷ Researchers have studied

psychological mechanisms for using OTC supplements among individuals. Earlier research proposed a study data tabulation model depicting self-diagnosis, self-treatment, and self-monitoring. Self-diagnosis describes the ability to introspect one’s own

inner bodily states and emotions. A specific symptom is identified as a sensation and is perceived as the “focal symptom” for subsequent treatment and monitoring. Self-treatment involves choosing a drug to alleviate the “focal symptom.” Self-monitoring entails a continued awareness of the focal system and of general well-being to evaluate the effect of therapy.^[1] Self-medication use increased during the COVID-19 pandemic.^[2][3]–[4] In the position statement from the AACE,⁵ the most common indication for use of the supplements reported in our case is “adrenal fatigue.” Our patient did not have such complaints, nor did he mention such conditions. These products often claim unproven benefits such as improvements in symptoms of anxiety, “brain fog,” decreased sexual drive, depression, emotional lability, lightheadedness, unexplained aches and pain.⁵ Our patient did not report such complaints, nor did he report benefits related to such complaints.

Thus, the pattern of behavior reported by the patient does not conform to the earlier reported indications for use of the product or to earlier reported benefits from the product. The authors speculate that an exogenous adrenal cortex supplement might induce feedback inhibition of rebound activation, which might alleviate BZD withdrawal severity.^[5],[6] As these products were not regulated, it remains unclear whether any components other than steroids might play a role to alleviate the symptoms of BZD withdrawal in our patient. The product was not available with the patient during his admission at our center. Our center does not have a required facility to run toxicologic tests. We could not run biochemical and toxicologic laboratory tests to examine and confirm the nature of the ingredients in the product. In this context, one could not rule out a placebo response as well.

This report adds to the literature on the well-known but inadequately reported patient self-medication behavior in BZD withdrawal. This case also adds to the literature on self-medication behavior during the COVID-19 pandemic. Thus, clinically, this case highlights the importance of specifically inquiring about OTC supplements used for self-medication during the assessment of substance use disorder. Supplements perceived as safe or natural may become integrated into maladaptive substance use and remain unrecognized during clinical evaluation. Routine and careful inquiry regarding unregulated supplements is therefore crucial during evaluation for substance use disorder.

Article Information

Published Online: November 5, 2026. https://doi.org/10.4088/PCC.26cr04286
© 2026 Physicians Postgraduate Press, Inc.
Prim Care Companion CNS Disord 2026;28(6):26cr04286
Submitted: May 25, 2026; accepted August 5, 2026.
To Cite: Munshi SA, Khanra S, Goyal N. Bovine-derived adrenal cortex supplement self-medication for benzodiazepine withdrawal. Prim Care Companion CNS Disord 2026;28(6):26cr04286.
Author Affiliations: Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India (Munshi, Goyal); Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India (Khanra).
Corresponding Author: Sourav Khanra, MD, Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi-834006, Jharkhand, India ([email protected]).
Financial Disclosure: None.
Funding/Support: None.
ORCID: https://orcid.org/0009-0001-6035-4914;
Sourav Khanra: https://orcid.org/0000-0002-8684-6773;
Nishant Goyal: https://orcid.org/0000-0002-9527-8261