Alcohol withdrawal: what is the benzodiazepine of choice?
OBJECTIVE
To review the literature concerning the use of benzodiazepines for treatment of alcohol withdrawal and to determine if the current literature assessment justifies the use of lorazepam as first-line therapy.


METHODS
A thorough review of the literature was performed with an online database (BRS Colleague). Articles directed at the targeted issue were chosen and additional references were obtained from the bibliographies of these articles.


METHODS
Clinical trials and case reports concerning the use of chlordiazepoxide, diazepam, and lorazepam in alcohol withdrawal treatment were reviewed.


RESULTS
Lorazepam is considered by many to be the drug of choice for alcohol withdrawal because it undergoes glucuronidation and has an intermediate half-life. These characteristics have suggested its superiority when treating elderly patients or patients with liver disease. However, some studies suggest that a drug with a longer half-life would provide smoother withdrawal. In addition, the number of patients with liver disease treated for alcohol withdrawal is unknown. These and other factors question the recommendation of lorazepam as the drug of choice.


CONCLUSIONS
Well-controlled comparison studies should be performed before recommending the routine use of lorazepam for treating alcohol withdrawal syndrome.
Bird
R D
RD
School of Pharmacy, West Virginia University, Morgantown.
Makela
E H
EH
D000430:Alcohol Withdrawal Delirium / Q000188:drug therapy*; D001569:Benzodiazepines / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002707:Chlordiazepoxide / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003975:Diazepam / Q000627:therapeutic use; D004333:Drug Administration Routes; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008140:Lorazepam / Q000627:therapeutic use; D008297:Male; D013375:Substance Withdrawal Syndrome / Q000145:classification / Q000188:drug therapy* / Q000191:economics
D001569:Benzodiazepines; D000431:Ethanol; D002707:Chlordiazepoxide; D008140:Lorazepam; D003975:Diazepam