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Which Benzodiazepine is best for alcohol withdrawal? Chlodiazepoxide vs. Lorazepam.

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 OR exp.substance withdrawal syndrome] OR [ex.alcohol withdrawal seizures OR aclohol withdrawal delerium OR alcoholic neuropathy] AND [exp.chlodiazepoxide OR] 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] 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.
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. lorazepam0.20 (0.01, 3.97)/ 0 vs. 2Small 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.


No statistically significant difference in drugs performance.

Clinical Bottom Line

Could use either drug to control symptoms.


  1. 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.