title: Symptom-triggered vs fixed-schedule doses of benzodiazepine for alcohol withdrawal: a randomized treatment trial.
abstract: BACKGROUND
  In alcohol withdrawal, fixed doses of benzodiazepine are generally recommended as a first-line pharmacologic approach. This study determines the benefits of an individualized treatment regimen on the quantity of benzodiazepine administered and the duration of its use during alcohol withdrawal treatment.
  
  
  METHODS
  We conducted a prospective, randomized, double-blind, controlled trial including 117 consecutive patients with alcohol dependence, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, entering an alcohol treatment program at both the Lausanne and Geneva university hospitals, Switzerland. Patients were randomized into 2 groups: (1) 56 were treated with oxazepam in response to the development of signs of alcohol withdrawal (symptom-triggered); and (2) 61 were treated with oxazepam every 6 hours with additional doses as needed (fixed-schedule). The administration of oxazepam in group 1 and additional oxazepam in group 2 was determined using a standardized measure of alcohol withdrawal. The main outcome measures were the total amount and duration of treatment with oxazepam, the incidence of complications, and the comfort level.
  
  
  RESULTS
  A total of 22 patients (39%) in the symptom-triggered group were treated with oxazepam vs 100% in the fixed-schedule group (P<.001). The mean oxazepam dose administered in the symptom-triggered group was 37.5 mg compared with 231.4 mg in the fixed-schedule group (P<.001). The mean duration of oxazepam treatment was 20.0 hours in the symptom-triggered group vs 62.7 hours in the fixed-schedule group (P<.001). Withdrawal complications were limited to a single episode of seizures in the symptom-triggered group. There were no differences in the measures of comfort between the 2 groups.
  
  
  CONCLUSIONS
  Symptom-triggered benzodiazepine treatment for alcohol withdrawal is safe, comfortable, and associated with a decrease in the quantity of medication and duration of treatment.
authors.affiliation: Alcohol Treatment Center, Mont-Paisible 16, CHUV-1011 Lausanne, Switzerland. jean-bernard.daeppen@inst.hospvd.ch
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Daeppen
authors.forename: Pascal
authors.initials: P
authors.lastname: Gache
authors.forename: Ulrika
authors.initials: U
authors.lastname: Landry
authors.forename: Eva
authors.initials: E
authors.lastname: Sekera
authors.forename: Verena
authors.initials: V
authors.lastname: Schweizer
authors.forename: Stéphane
authors.initials: S
authors.lastname: Gloor
authors.forename: Bertrand
authors.initials: B
authors.lastname: Yersin
mesh_terms: D000430:Alcohol Withdrawal Delirium / Q000517:prevention & control*; D020270:Alcohol Withdrawal Seizures / Q000517:prevention & control*; D014151:Anti-Anxiety Agents / Q000008:administration & dosage*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010076:Oxazepam / Q000008:administration & dosage*; D011446:Prospective Studies; D011788:Quality of Life; D018709:Statistics, Nonparametric; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy* / Q000209:etiology; D013557:Switzerland
chemical_list: D014151:Anti-Anxiety Agents; D000431:Ethanol; D010076:Oxazepam