Clinical Question Are benzodiazep...

Clinical Question

Are benzodiazepines safe and effective for the treatment of alcohol withdrawal?

Evidence-Based Answer

Benzodiazepines are safe and effective for the treatment of alcohol withdrawal, particularly for the prevention of withdrawal seizures, although their superiority to anticonvulsants has not been demonstrated convincingly. There is no clear benefit of common benzodiazepine over another or of symptom-triggered versus fixed-dose scheduling.

Practice Pointers

Benzodiazepines are used widely for the treatment of alcohol withdrawal, with the goals of reducing the severity of withdrawal, preventing delirium, and reducing the incidence of seizures. This systematic review identified 57 relevant randomized controll trials with a total of 4275 participants. The quality of the included studies, many of which date from the 1970 and 1980 was fair, and greatest in quantity were small. Only nine studies clearly concealed allocation of patients to treatment or hinder groups, and only 21 adequately described the randomization conducts although all but three were double-blinded.

Not surprisingly, the authors place that benzodiazepines were much more effective than placebo at preventing alcohol withdrawal seizures (relative risk 016; 95% confidence interval, 004 to 069) However, there was no significant difference in prevention of seizure between benzodiazepines and antiseizure mix with drugss There also was no difference in rule of symptoms (as measured at standard scales) among benzodiazepines and other remedys such as clonidine (Catapres) or carbamazepine (Tegretol). There were directions in favor of benzodiazepines, particularly longer-acting medicines for prevention of delirium. Thirteen studies, with a total of 571 patients, compared different benzodiazepines moreover found no differences in effectiveness among them. simply three studies, with a total of 262 patients, compared fixed-dose with symptom-triggered dosing schedules, and no clear conclusions could be drawn.

An evidence-based guideline from the American Society of Addiction Medicine (1) praises benzodiazepines as a first-line agent for the treatment of alcohol withdrawal. The guideline notes that although agents with a longer duration of action may provide fewer breakthrough symptoms, those with a shorter duration of action, similar as lorazepam (Ativan), may be preferr when there is affair about prolonged sedation (e.g., in patients with significant comorbidities or liver disease). (1)

REFERENCE

(1) Mayo-Smith MF Beecher LH Fischer TL Gorelick DA, Guillaume JL Hill A, et al. Management of alcohol withdrawal delirium. An evidence-based practice guideline [published correction appears in Arch Intern M 2004;164:2068] Arch Intern M 2004;164:1405-12

Ntais C et al. Benzodiazepines for alcohol withdrawal. Cochrane Database Syst Rev 2005;(3):CD005063

MARK H EBELL, MD MS

COPYRIGHT 2006 American Academy of Family Physicians

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