7/28/2019 Alcohol Withdrawal Syndromes Presentation USC

1/26

Alcohol Withdrawal Syndromes

7/28/2019 Alcohol Withdrawal Syndromes Presentation USC

2/26

Should You Treat This Patients

Alcohol Withdrawal With

Benzodiazepines?! Meta-analysis of RCTs of benzodiazepines for the treatment ofalcohol withdrawal

! 11 RCTs identified, most involving small samples of patients(n=1286) and different outcome measures

! 3 RCTs found that benzodiazepines were superior to placebo (OR= 3.3)

! 2 studies that compared different benzodiazepines to each otherdid not show differences in efficacy

Holbrook A., et al. Meta-analysis of benzodiazepine use in the treatment ofacute alcohol withdrawal.

7/28/2019 Alcohol Withdrawal Syndromes Presentation USC

3/26

Options For Benzodiazepines

! Diazepam usually favored b/c of fast onset of actionand longer half life

! Oral dosing works just as quickly as IV dosing! Longer half life may be harmful, particularly in elderly

or those with severe liver disease

! In those cases a shorter acting benzodiazepine likelorazepam should be used

7/28/2019 Alcohol Withdrawal Syndromes Presentation USC

4/26

Is it better to give PRN dosing or a

standing dose of benzodiazepines?! Randomized, double blind, placebo controlled trial of 2 benzodiazepine strategies (PRN

vs. fixed dose)

! Enrolled patients admitted to an alcohol treatment inpt program, whose last drink was