Which Benzodiazepine is best for alcohol withdrawal? Chlodiazepoxide vs. Lorazepam.
- Report By: Fiona Reid - Medical Student
- Search checked by Fiona Reid - Medical Student
- Institution: University of Manchester
- Date Submitted: 7th July 2011
- Last Modified: 11th July 2011
-
Status:
Blue (submitted but not checked)
Three Part Question
In [adults thought to be withdrawing from alcohol] is [Lorazepam better than Chlordiazepoxide] at [treating alcohol withdrawal symptoms]Clinical Scenario
Patient is experiencing symptoms of alcohol withdrawal. You want to know which is the best benzodiazepine to give.Search Strategy
Ovid interface.Medline 1948 to week 2 June 2011.
{[exp.ethanol OR alcohol$.mp] AND [substance withdrawal syndrome.mp OR exp.substance withdrawal syndrome] OR [ex.alcohol withdrawal seizures OR aclohol withdrawal delerium OR alcoholic neuropathy] AND [exp.chlodiazepoxide OR librium.mp] AND [exp.lorazepam]}LIMIT to english language AND human.
Embase 1980 to 2011 week 23
{[exp.alcohol withdrawal OR exp.delirium tremens] AND [exp.chordiazepoxide OR librium.mp] AND [exp.lorazepam]}LIMIT to english language AND human.
CINAHL 1994-2011
[alcohol withdrawal] AND [chlordiazepoxide OR librium] AND [lorazepam]
Search Outcome
Medline had 15 articles, Embase had 127 articles and CINAHL had 16 articles. A Cochrane review was found to have reviewed all relevant papers up to 2010 and there have been no new studies completed since then.Relevant Paper(s)
| Author, date and country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Amato L. et.al. 2010 Italy | Cochrane review- 64 studies with a totally of 4309 patients were reviewed. The comparison of Chlordiazepoxide an Lorazepam only contained two reviews, one of 100 patients, the other with 50 patients. | Cochrane systematic review of randomised controlled trails. | Alcohol withdrawal seizure relative risk ratio (R.R)/ no. of events: chlordiazepoxide vs. lorazepam | 0.20 (0.01, 3.97)/ 0 vs. 2 | Small numbers in each group. |
| Alcohol withdrawal delirium relative risk/ no. of events: lorazepam vs. chlordiazepoxide. | 0.33 (0.01, 7.99) / 0 vs. 1 | ||||
| CIWA-Ar score at 48 hours: lorazepam vs. chlordiazepoxide. | MD 0.00 (-0.06, 0.06) | ||||
| CIWA-Ar score at end of treatment. lorazepam vs. chlordiazepoxide. | MD 0.00 (-0.51, 0.51) | ||||
| Adverse events as a no. of participants with at least one adverse event R.R/ no. of events. lorazepam vs. chlordiazepoxide. | 2.00 (0.19, 21.36) 2 vs. 1 | ||||
| Drop outs R.R./ no. of events. lorazepam vs. chlordiazepoxide. | 0.75 (0.24, 2.37) 7 vs. 9 | ||||
| Drop outs due to adverse events. lorazepam vs. chlordiazepoxide. | None in either group. |
Comment(s)
No statistically significant difference in drugs performance.Clinical Bottom Line
Could use either drug to control symptoms.References
- Amato, L; Minozzi, S; Vecchi, S; Davoli, M. Benzodiazepines for alcohol withdrawal. Cochrane Database of Systematic Reviews 2010; Issue 3. Art. No.: CD005063. DOI: 10.1002/14651858.CD005063.pub3.