Benzodiazepine loading versus symptom-triggered treatment of alcohol withdrawal: A prospective, randomized clinical trial

General Hospital Psychiatry

Volumn 34, Issue 6, 2012, Pages 611-617

  Maldonado, José R ^a   Nguyen, Long H ^b   Schader, E Merritt ^c   Brooks, John O ^d  

^a STANFORD UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b VETERANS AFFAIRS MEDICAL CENTER   (United States)

^c Community Solutions ^*  (United States)

^d UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

Alcohol; Benzodiazepines; Diazepam; Loading method; Lorazepam; Symptom triggered; Withdrawal

Indexed keywords

BENZODIAZEPINE DERIVATIVE; DIAZEPAM; LORAZEPAM;

ADULT; AGED; AGITATION; ALCOHOL WITHDRAWAL; ARTICLE; AUTONOMIC NERVOUS SYSTEM FUNCTION; CLINICAL ARTICLE; CLINICAL EFFECTIVENESS; CLINICAL INSTITUTE WITHDRAWAL ASSESSMENT FOR ALCOHOL REVISED SCALE; CONTROLLED STUDY; DELIRIUM TREMENS; FEMALE; HUMAN; LENGTH OF STAY; MALE; MULTICENTER STUDY; OPEN STUDY; PROSPECTIVE STUDY; RANDOMIZED CONTROLLED TRIAL; RATING SCALE; RESPIRATION DEPRESSION; SEDATION; SIDE EFFECT; SYSTOLIC BLOOD PRESSURE; TERTIARY HEALTH CARE; UNITED STATES;

ADULT; AGED; AGED, 80 AND OVER; BENZODIAZEPINES; CENTRAL NERVOUS SYSTEM DEPRESSANTS; CHEMOPREVENTION; CLINICAL PROTOCOLS; ETHANOL; FEMALE; HUMANS; MALE; MIDDLE AGED; PROSPECTIVE STUDIES; SUBSTANCE WITHDRAWAL SYNDROME; TIME FACTORS; TREATMENT OUTCOME;

EID: 84867884910     PISSN: 01638343     EISSN: 18737714     Source Type: Journal    
DOI: 10.1016/j.genhosppsych.2012.06.016     Document Type: Article

References (49)

1. Lieber C.S. Medical disorders of alcoholism. N Engl J Med 1995, 333(16):1058-1065.
2. Williams G.D., et al. Apparent per capita alcohol consumption: national, state and regional trends, 1977-94 1996, 3-6. N.I.o.A.A.a. Alcoholism (Ed.).
3. SAMHSA Results from the 2008 National Survey on Drug Use and Health: national findings 2009, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville (MD).
4. Robins L.N., et al. Lifetime prevalence of specific psychiatric disorders in three sites. Arch Gen Psychiatry 1984, 41(10):949-958.
5. Tracy S.W., Trafton J.A., Humphreys K. The Department of Veterans Affairs Substance Abuse Treatment System: results of the 2003 Drug and Alcohol Program Survey 2004, U.S. Department of Veterans Affairs, Veterans Affairs Health Care System, Program Evaluation and Resource Center, Palo Alto (CA).
6. Moore R.D., et al. Prevalence, detection, and treatment of alcoholism in hospitalized patients. JAMA 1989, 261(3):403-407.
7. Saitz R., O'Malley S.S. Pharmacotherapies for alcohol abuse. Withdrawal and treatment. Med Clin North Am 1997, 81(4):881-907.
8. O'Brien J.M., et al. Alcohol dependence is independently associated with sepsis, septic shock, and hospital mortality among adult intensive care unit patients. Crit Care Med 2007, 35(2):345-350.
9. Holbrook A.M., et al. Meta-analysis of benzodiazepine use in the treatment of acute alcohol withdrawal. Cmaj 1999, 160(5):649-655.
10. Maldonado J., DiMartini A., Owen J. Psychopharmacological treatment of substance use disorders in the medically ill. Clinical handbook of psychopharmacology in the medically ill 2010, 537-555. APPI, VA. S. Ferrando (Ed.).
11. McKeon A., Frye M.A., Delanty N. The alcohol withdrawal syndrome. J Neurol Neurosurg Psychiatry 2008, 79(8):854-862.
12. Maldonado J. An approach to the patient with substance use and abuse. Med Clin North Am 2010:94(6):1169-205, x-i.
13. Kosten T.R., O'Connor P.G. Management of drug and alcohol withdrawal. N Engl J Med 2003, 348(18):1786-1795.
14. Mayo-Smith M.F. 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, 278(2):144-151.
15. Stern T.A., et al. Current approaches to the recognition and treatment of alcohol withdrawal and delirium tremens: "old wine in new bottles" or "new wine in old bottles" Prim Care Companion J Clin Psychiat 2010, 12(3).
16. Ntais C., et al. Benzodiazepines for alcohol withdrawal. Cochrane Database Syst Rev 2005, (3):CD005063.
17. Sellers E.M., et al. Diazepam loading: simplified treatment of alcohol withdrawal. Clin Pharmacol Ther 1983, 34(6):822-826.
18. Miller N.S. Pharmacotherapy in alcoholism. J Addict Dis 1995, 14(1):23-46.
19. Ritson B., Chick J. Comparison of two benzodiazepines in the treatment of alcohol withdrawal: effects on symptoms and cognitive recovery. Drug Alcohol Depend 1986, 18(4):329-334.
20. Saitz R., et al. Individualized treatment for alcohol withdrawal. A randomized double-blind controlled trial. JAMA 1994, 272(7):519-523.
21. Miller W.C., McCurdy L. A double-blind comparison of the efficacy and safety of lorazepam and diazepam in the treatment of the acute alcohol withdrawal syndrome. Clin Ther 1984, 6(3):364-371.
22. Solomon J., Rouck L.A., Koepke H.H. Double-blind comparison of lorazepam and chlordiazepoxide in the treatment of the acute alcohol abstinence syndrome. Clin Ther 1983, 6(1):52-58.
23. McKay A, Koranda A, Axen D. Using a symptom-triggered approach to manage patients in acute alcohol withdrawal. Medsurg Nurs 2004:13(1):15-20, 31; quiz 21.
24. Sullivan J.T., et al. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict 1989, 84(11):1353-1357.
25. Jaeger T.M., Lohr R.H., Pankratz V.S. Symptom-triggered therapy for alcohol withdrawal syndrome in medical inpatients. Mayo Clin Proc 2001, 76(7):695-701.
26. Daeppen J.B., et al. Symptom-triggered vs fixed-schedule doses of benzodiazepine for alcohol withdrawal: a randomized treatment trial. Arch Intern Med 2002, 162(10):1117-1121.
27. Fitzgerald F.T. As the occasion arises: PRN sedative orders in alcohol withdrawal treatment. Arch Intern Med 2002, 162(10):1093-1094.
28. Hardern R., Page A.V. An audit of symptom triggered chlordiazepoxide treatment of alcohol withdrawal on a medical admissions unit. Emerg Med J 2005, 22(11):805-806.
29. Wartenberg A.A., et al. Detoxification of alcoholics: improving care by symptom-triggered sedation. Alcohol Clin Exp Res 1990, 14(1):71-75.
30. DeCarolis D.D., et al. Symptom-driven lorazepam protocol for treatment of severe alcohol withdrawal delirium in the intensive care unit. Pharmacotherapy 2007, 27(4):510-518.
31. Shaw G.K. Detoxification: the use of benzodiazepines. Alcohol Alcohol 1995, 30(6):765-770.
32. Bird R.D., Makela E.H. Alcohol withdrawal: what is the benzodiazepine of choice?. Ann Pharmacother 1994, 28(1):67-71.
33. Erstad B.L., Cotugno C.L. Management of alcohol withdrawal. Am J Health Syst Pharm 1995, 52(7):697-709.
34. Lejoyeux M., Solomon J., Ades J. Benzodiazepine treatment for alcohol-dependent patients. Alcohol Alcohol 1998, 33(6):563-575.
35. Liskow B.I., Goodwin D.W. Pharmacological treatment of alcohol intoxication, withdrawal and dependence: a critical review. J Stud Alcohol 1987, 48(4):356-370.
36. Mayo-Smith M.F., et al. Management of alcohol withdrawal delirium. An evidence-based practice guideline. Arch Intern Med 2004, 164(13):1405-1412.
37. Saitz R., Friedman L.S., Mayo-Smith M.F. Alcohol withdrawal: a nationwide survey of inpatient treatment practices. J Gen Intern Med 1995, 10(9):479-487.
38. Colon E.A., Popkin M.K. Anxiety and panic. Textbook of consultation-liason psychiatry 1996, 402-425. American Psychiatric Association Press, Washington, DC. J.R. Rundell, M.G. Wise (Eds.).
39. Ahmed S., Chadwick D., Walker R.J. The management of alcohol-related seizures: an overview. Hosp Med 2000, 61(11):793-796.
40. Sarff M., Gold J.A. Alcohol withdrawal syndromes in the intensive care unit. Crit Care Med 2010, 38(9 Suppl):S494-S501.
41. Amato L., Minozzi S., Davoli M. Efficacy and safety of pharmacological interventions for the treatment of the alcohol withdrawal syndrome. Cochrane Database Syst Rev 2011, (6):CD008537.
42. Caputo F., Bernardi M. Medications acting on the GABA system in the treatment of alcoholic patients. Curr Pharm Des 2010, 16(19):2118-2125.
43. Caputo F., et al. Gamma hydroxybutyric acid (GHB) for the treatment of alcohol dependence: a review. Int J Environ Res Public Health 2009, 6(6):1917-1929.
44. Leone M.A., et al. Gamma-hydroxybutyrate (GHB) for treatment of alcohol withdrawal and prevention of relapses. Cochrane Database Syst Rev 2010, (2):CD006266.
45. Liu J., Wang L. Baclofen for alcohol withdrawal. Cochrane database of systematic reviews 2011, (1):CD008502.
46. Ait-Daoud N., Malcolm R.J., Johnson B.A. An overview of medications for the treatment of alcohol withdrawal and alcohol dependence with an emphasis on the use of older and newer anticonvulsants. Addict Behav 2006, 31(9):1628-1649.
47. Minozzi S, et al. Anticonvulsants for alcohol withdrawal. Cochrane database of systematic reviews. 2010(3):CD005064.
48. Muzyk A.J., et al. Role of {alpha}2-agonists in the treatment of acute alcohol withdrawal. Ann Pharmacother 2011, 45(5):649-657.
49. Amato L., et al. Benzodiazepines for alcohol withdrawal. Cochrane Database Syst Rev 2010, 3:CD005063.