Symptom-triggered benzodiazepine treatment for alcohol withdrawal [Classics Series]

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1. For patients withdrawing from alcohol, a symptom-triggered pharmacologic therapy may decrease detoxification time without compromising the safety or comfort of the patient

2. Symptom-triggered individualized benzodiazephine administration reduces the intensity and duration of oxazepam use during withdrawal treatment

Original Date of Publication: May 27, 2002

Study Rundown: Fixed doses of benzodiazepine are considered the first-line pharmacologic approach when treating patients with alcohol withdrawal. In this landmark study, withdrawing patients were randomized into two groups – in the first group, patients underwent individualized treatment with oxazepam in response to withdrawal symptoms and in the second group, patients were treated with a fixed amount of oxazepam with additional doses given only as needed. It was determined that the symptom-triggered patient group not only used 6 times less oxazepam but also experienced a shorter treatment duration than did the fixed-schedule group of patients. The difference in oxazepam use was not tied to any changes in safety, withdrawal intensity or comfort level of the patients. In summary, this study supports the use of symptom-triggered benzodiazepine administration in patients suffering alcohol withdrawal.

Click to read the study in Archives of Internal Medicine

In-Depth [randomized, controlled study]: This double-blinded randomized control trial was originally published in the Archives of Internal Medicine in May of 2002. An uninvolved pharmacist randomized all 117 eligible patients admitted to the alcohol treatment inpatient program, a clinic associated with the Lausanne University hospital, into clusters of 10 participants to either the symptom-triggered or fixed schedule group. Fixed-schedule subjects received a 30 mg dose of oxazepam every 6 hours, and subsequently, 8 doses of 15 mg. Shortly after administration, patients would be administered additional drugs, depending on their Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar) score.  Symptom-triggered subjects would receive a placebo every 6 hours and were administered oxazepam only if their CIWA-Ar score reached certain pre-determined thresholds. In comparing the two groups, only 39% in the symptom-triggered group were treated with oxazepam, which stood in great contrast to the 100% treated in the fixed schedule group (P < .001). The mean total oxazepam dose administered to the symptom-triggered and fixed-schedule groups were 37.5 mg and 231.4 mg (P < .001) respectively.  The mean duration of treatment in the symptom triggered group was 20.0 hours, which was significantly lower than the mean duration time of 62.7 hours in the fixed schedule group (P < .001).

Despite these differences, there were no distinctions in comfort level noted between individuals in the two groups, as measured by comparing the CIWA-Ar scores of each patient. In sum, symptom-triggered benzodiazepine treatment in alcohol withdrawal patients is safe, and can lead to a reduction in the intensity and duration of oxazepam use.

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