 |
|
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.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED ARTICLES
As the Occasion Arises: PRN Sedative Orders in Alcohol Withdrawal Treatment
Faith T. Fitzgerald
Arch Intern Med. 2002;162(10):1093-1094.
EXTRACT
| FULL TEXT
Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 2002;162(10):1199-1200.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
A multi-centre survey of inpatient pharmacological management strategies for alcohol withdrawal
Ward et al.
QJM 2009;102:773-780.
ABSTRACT
| FULL TEXT
The alcohol withdrawal syndrome
McKeon et al.
J. Neurol. Neurosurg. Psychiatry 2008;79:854-862.
ABSTRACT
| FULL TEXT
Successful Implementation of an Alcohol-Withdrawal Pathway in a General Hospital
Repper-DeLisi et al.
Psychosomatics 2008;49:292-299.
ABSTRACT
| FULL TEXT
Inappropriate Use of Symptom-Triggered Therapy for Alcohol Withdrawal in the General Hospital
Hecksel et al.
Mayo Clin Proc. 2008;83:274-279.
ABSTRACT
| FULL TEXT
A POSSIBLE WAY TO MOTIVATE AMBIVALENT PATIENTS TO UNDERGO DETOXIFICATION
BERTHOLET and DAEPPEN
Alcohol Alcohol 2006;41:205-205.
FULL TEXT
Management of Delirium Tremens
DeBellis et al.
J Intensive Care Med 2005;20:164-173.
ABSTRACT
Evidence-Based Guidelines for the Pharmacological Management of Substance Misuse, Addiction and Comorbidity: Recommendations from the British Association for Psychopharmacology
Lingford-Hughes et al.
J Psychopharmacol 2004;18:293-335.
Percentage Set Straight
Daeppen and Fitzgerald
Arch Intern Med 2002;162:2379-2379.
FULL TEXT
As the Occasion Arises: PRN Sedative Orders in Alcohol Withdrawal Treatment
Fitzgerald
Arch Intern Med 2002;162:1093-1094.
FULL TEXT
|
