Alcohol withdrawal pharmacotherapy for inpatients with medical comorbidity.
Studies show that symptom-triggered dosing is best for treatment of alcohol withdrawal in patients on chemical dependence wards without other illness. On general medical hospital wards, withdrawal may be affected by comorbid medical illness. A clinical trial was undertaken to determine whether there is a difference between symptom-triggered (ST) and fixed-schedule (FS) dosing of lorazepam in patients hospitalized on general medical wards at a university medical center. One hundred eighty-three subjects were assessed by their nurses with the Revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale. Subjects in the ST arm received lorazepam doses based on CIWA-Ar score. Subjects in the FS arm received scheduled lorazepam with tapering over 4 days. Symptom-triggered dosing for alcohol withdrawal for general medicine inpatients results in less lorazepam given with similar reduction in CIWA-Ar scores for the first 2 days, but a higher proportion of protocol errors.
Weaver
Michael F
MF
Department of Internal Medicine and Psychiatry, Virginia Commonwealth University, USA. mfweaver@vcu.edu
Hoffman
Heather J
HJ
Johnson
Robert E
RE
Mauck
Kimberly
K
D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000430:Alcohol Withdrawal Delirium / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000451:nursing; D015331:Cohort Studies; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007388:Internal Medicine; D008140:Lorazepam / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment; D011446:Prospective Studies
D006993:Hypnotics and Sedatives; D008140:Lorazepam