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Symptom-Triggered vs Fixed-Schedule Doses of Benzodiazepine for Alcohol Withdrawal
A Randomized Treatment Trial
Jean-Bernard Daeppen, MD;
Pascal Gache, MD;
Ulrika Landry, BA;
Eva Sekera, MD;
Verena Schweizer, MD;
Stéphane Gloor, PhD;
Bertrand Yersin, MD
Arch Intern Med. 2002;162:1117-1121.
Background In alcohol withdrawal, fixed doses of benzodiazepine are generally recommended
as a first-line pharmacologic approach. This study determines the benefits
of an individualized treatment regimen on the quantity of benzodiazepine administered
and the duration of its use during alcohol withdrawal treatment.
Methods We conducted a prospective, randomized, double-blind, controlled trial
including 117 consecutive patients with alcohol dependence, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition, entering an alcohol treatment program at both the Lausanne
and Geneva university hospitals, Switzerland. Patients were randomized into
2 groups: (1) 56 were treated with oxazepam in response to the development
of signs of alcohol withdrawal (symptom-triggered); and (2) 61 were treated
with oxazepam every 6 hours with additional doses as needed (fixed-schedule).
The administration of oxazepam in group 1 and additional oxazepam in group
2 was determined using a standardized measure of alcohol withdrawal. The main
outcome measures were the total amount and duration of treatment with oxazepam,
the incidence of complications, and the comfort level.
Results A total of 22 patients (39%) in the symptom-triggered group were treated
with oxazepam vs 100% in the fixed-schedule group (P<.001).
The mean oxazepam dose administered in the symptom-triggered group was 37.5
mg compared with 231.4 mg in the fixed-schedule group (P<.001). The mean duration of oxazepam treatment was 20.0 hours
in the symptom-triggered group vs 62.7 hours in the fixed-schedule group (P<.001). Withdrawal complications were limited to a
single episode of seizures in the symptom-triggered group. There were no differences
in the measures of comfort between the 2 groups.
Conclusions Symptom-triggered benzodiazepine treatment for alcohol withdrawal is
safe, comfortable, and associated with a decrease in the quantity of medication
and duration of treatment.
From the Alcohol Treatment Centers, Lausanne (Drs Daeppen, Schweizer,
Gloor, and Yersin and Ms Landry) and Geneva (Drs Gache and Sekera), Switzerland.
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