Pharmacological management of alcohol withdrawal
Sübutlu məlumatların xülasələri
04.04.2018 • Sonuncu dəyişiklik 04.04.2018
Editors
Benzodiazepines are suitable agents for alcohol withdrawal. Phenothiazines alone may increase the risk for seizures.
A systematic review including 65 prospective controlled trials with 42 different medications was abstracted in DARE. The results were as follows:
Risk difference with benzodiazepine vs placebo for delirium: -4.9 cases of delirium/100 patients (95% CI -9.0 to -0.7).
Risk difference with benzodiazepines vs placebo for seizure: -7.7 cases of seizures/100 patients (95% CI -12.0 to -3.5).
Risk difference with long acting as opposed to short acting benzodiazepine for seizure: -6.7 cases of seizure/100 patients (95% CI -13.0 to 0.0).
Risk difference with phenothiazine vs placebo for delirium: 0.0
Risk difference with phenothiazine vs placebo for seizure: +4.6 cases of seizure/100 patients (95% CI -2.6 to 11.9).
Risk difference with phenothiazine vs cross-tolerant medication (benzodiazepine or paraldehyde) for seizure: +11.4 (95% CI +6.2 to +16.6).
Another systematic review
including 14 placebo-controlled studies with a total of 1,040 subjects was abstracted in DARE. All 12 compounds were reported to be superior to placebo, but this has only been replicated for benzodiazepines and chlormethiazole.
A third systematic review
including 11 RCTs with a total of 1286 subjects was abstracted in DARE. Five RCTs involved chlordiazepoxide, 3 used diazepam, 2 involved oxazepam and 1 used lorazepam. Pooled results of 3 studies found benzodiazepines to be superior to placebo (OR 3.28, 95% CI 1.30 to 8.28) as measured by a reduction in CIWA-A score within 2 days. Efficacy data from 9 trials on comparisons between benzodiazepines and other drugs, including beta-blockers, carbamazepine and chlonidine, could not be pooled, but none of the alternative
drugs was found to be more beneficial than benzodiazepines. The occurrence of adverse effects showed no significant difference (OR 0.67, 95% CI 0.34 to 1.32) between benzodiazepines and other drugs.
The following decision support rules contain links to this evidence summary:
- Benzodiazepines rather than phenothiazines for alcohol withdrawal
Ədəbiyyat
- Mayo-Smith MF. Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal. JAMA 1997 Jul 9;278(2):144-51.
Williams D, McBride AJ. The drug treatment of alcohol withdrawal symptoms: a systematic review. Alcohol Alcohol 1998 Mar-Apr;33(2):103-15.
Holbrook AM, Crowther R, Lotter A, Cheng C, King D. Meta-analysis of benzodiazepine use in the treatment of acute alcohol withdrawal. CMAJ 1999 Mar 9;160(5):649-55.