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Which Benzodiazepine is best for alcohol withdrawal? Chlordiazepoxide vs. Diazepam.

Three Part Question

In [patients though to be witdrawing from alcohol] is [Diazepam better than Chlordiazepoxide] at [treating alcohol withdrawal symptoms]?

Clinical Scenario

Patient is in alcohol withdrawal. You want to know which is the best benzodiazepine to prescribe.

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.chlordiazepoxide OR] AND [exp.diazepam]}LIMIT to english language AND human.
Embase 1980 to 2011 week 23.
{[exp.alcohol withdrawal OR exp.delirium tremens] AND [chlordiazepoxide OR librium] AND [diazepam]}LIMIT to english language AND human.
CINAHL 1994 to 2011
[alcohol withdrawal] AND [chlordiazepoxide OR librium] AND [diazepam]

Search Outcome

Medline found 26 articles, Embase found 155 articles and CINAHL found 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. In the comparison between Diazepam and Chlordiazepoxide, 3 studies were found containing a total of 61 patients.Cochrane review of randomised controlled trails.Alcohol withdrawal seizure relative risk ratio (R.R)/ no. of events. Chlordiazepoxide vs. Diazepam.0.33 (0.01, 7.45)/ 0 vs. 1Very small number of patients studied.
CIWA-Ar score at 48 hours. Diazepam vs. Chlordiazepoxide.MD -4.50 (-11.44 to 2.44)
CIWA-Ar score at end of treatment. Diazepam vs. ChlordiazepoxideMD -3.30 (-10.79 to 4.19)
Adverse events as a no. of participants with at least one adverse event R.R/ no. of events. Chlordiazepoxide vs. Diazepam.3.00 (0.14 to 63.15)/ 1 vs. 0.
Severe, life-threatening adverse events. Chlordiazepoxide vs. Diazepam.None in either group.
Drop out R.R./ no. of events. Chlordiazepoxide vs. Diazepam.6.00 (0.37 to 98.65)/ 4 vs. 0
Drop outs due to adverse events R.R/ no. of events. Chlordiazepoxide vs. Diazepam.3.00 (0.14 to 63.15)


No statistically significant difference between the drug's performance.

Clinical Bottom Line

Either drug could be used to treat alcohol withdrawal.


  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.