Pharmacological Management of Alcohol Withdrawal

A systematic review 1 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).

The following decision support rules contain links to this evidence summary:

• Benzodiazepines rather than phenothiazines for alcohol withdrawal http://www.ebmeds.org/ebmeds/ebmeds_home.asp?mode=scripts&submode=view&id=scr00515&country=UK

References

• 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. [PubMed] [DARE]