Benzodiazepines for alcohol withdrawal
Trial question
Is symptom-triggered doses of benzodiazepine superior to fixed-schedule doses of benzodiazepine in patients with alcohol withdrawal?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
23.0% female
77.0% male
N = 117
117 patients (27 female, 90 male).
Inclusion criteria: patients with alcohol dependence entering an alcohol treatment program.
Key exclusion criteria: last alcoholic beverage intake > 72 hours prior to admission; daily use of medication for treatment of alcohol withdrawal for the 30 days prior to admission (ie, benzodiazepines, barbiturates, or clomethiazole); major cognitive, psychiatric, or medical comorbidity; opiate or stimulant dependence; and/or no fluency in French.
Interventions
N=56 symptom-triggered benzodiazepine administration (oxazepam in response to the development of signs of alcohol withdrawal).
N=61 fixed-schedule benzodiazepine administration (oxazepam every 6 hours with additional doses as needed).
Primary outcome
Total amount of oxazepam administered
37.5 mg
231.4 mg
231.4 mg
173.6 mg
115.7 mg
57.9 mg
0.0 mg
Symptom-triggered benzodiazepine
administration
Fixed-schedule benzodiazepine
administration
Significant
decrease ▼
Significant decrease in total amount of oxazepam administered (37.5 mg vs. 231.4 mg; ARD -193.9, 95% CI -308.95 to -78.85).
Secondary outcomes
Significant decrease in duration of treatment with oxazepam (20 hours vs. 62.7 hours; MD -42.7, 95% CI -68.04 to -17.36).
Safety outcomes
Significant difference in seizures (1 vs. 0).
Conclusion
In patients with alcohol dependence entering an alcohol treatment program, symptom-triggered benzodiazepine administration was superior to fixed-schedule benzodiazepine administration with respect to total amount of oxazepam administered.
Reference
Daeppen JB, Gache P, Landry U et al. Symptom-triggered vs fixed-schedule doses of benzodiazepine for alcohol withdrawal: a randomized treatment trial. Arch Intern Med. 2002 May 27;162(10):1117-21.
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