Benzodiazepines for alcohol withdrawal
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Benzodiazepines for alcohol withdrawal.

Amato L., Minozzi S., Vecchi S. et al.
Cochrane Database of Systematic Reviews: 2010, 3, Art. No.: CD005063.

Rigorous review and synthesis of randomised trials indicates the superiority of benzodiazepines for controlling the potentially serious medical consequences of withdrawing from dependent drinking.

Summary Benzodiazepines have been widely used for the treatment of alcohol withdrawal symptoms, but it is not known whether different benzodiazepines and different regimens of administration may have the same merits. This review aimed to evaluate the effectiveness and safety of benzodiazepines in the treatment of alcohol withdrawal by synthesising results from trials which had allocated patients at random to a benzodiazepine versus a placebo, some other pharmacological treatment, or another benzodiazepine. Sixty-four such studies were found involving 4,309 participants.

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Key points

This Cochrane review summarises evidence from 64 randomised controlled trials evaluating the effectiveness and safety of benzodiazepines in the treatment of alcohol withdrawal symptoms.

The available data show that benzodiazepines are effective against alcohol withdrawal seizures when compared to placebo and there is a potentially protective benefit for many outcomes when compared with other drugs.

Data on safety outcomes is sparse and fragmented.

Main findings

Compared to placebos, three studies with 324 participants indicated that benzodiazepines were significantly better at preventing seizures, but there were no statistically significant differences for the other outcomes considered.

Comparing to other drugs, there were non-significant trends in favour of benzodiazepines in respect of seizures and delirium, severe life-threatening side-effects, treatment drop-outs, drop-outs due to side-effects, and global improvement in alcohol withdrawal syndromes. However, there were non-significant trend in favour of other drugs for alcohol withdrawal symptoms as measured by pre-specified scales at 48 hours and at the end of treatment.

There were no statistically significant differences between different benzodiazepines, but chlordiazepoxide performed better than other variants.

There were no statistically significant improvements consequent upon adding benzodiazepines to other drugs.

Drugs can be administered according to a fixed schedule or as indicated by the severity of symptoms. Results from a single study with 159 participants favoured a symptom-triggered regimen, which led to lower alcohol withdrawal severity scores at the end of treatment. However, differences in isolated trials should be interpreted very cautiously.

The authors’ conclusions

Compared to placebo, benzodiazepines showed a protective benefit against alcohol withdrawal symptoms, in particular seizures, and compared to other drugs, potentially protective benefits in respect of several outcomes. Nevertheless, no definite conclusions about the effectiveness and safety of benzodiazepines was possible, because of differences between the trials both in interventions and assessments of outcomes.

Last revised 19 June 2015. First uploaded 19 June 2015

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