Gamma-hydroxybutyric acid versus clomethiazole for the treatment of alcohol withdrawal syndrome in a medical intensive care unit: an open, single-center randomized study.
BACKGROUND
Clomethiazole (CLO) has been shown to be effective in treating alcohol withdrawal syndrome (AWS). Gamma-Hydroxybutyric acid (GHB) has also been introduced in the treatment of alcoholic patients and is effective in surgical intensive care unit (ICU) patients in preventing and treating AWS. There are no comparative studies between CLO and GHB in a medical ICU setting.


METHODS
Twenty-six alcoholic patients with severe AWS and concomitant medical diseases were randomally enrolled in the study. CLO was given orally to 12 patients in a dosage of 250 mg every 4 hours as a liquid; GHB (initially 30 mg/kg body weight (BW) followed by 15 mg/kg BW) was administered intravenously to 14 patients. Four major AWS symptoms (tremor, sweating, nausea, restlessness) were scored, and the administration of additional medication was registered.


RESULTS
GHB was more effective in treating AWS symptoms. In the GHB group, AWS score dropped from 6.6 +/- 2.6 to 1.8 +/- 2.1 (p <.01), while in the CLO group, the score dropped from 6 +/- 2.5 to 4.1 +/- 2.4 (n. s.). Differences between groups were significant (p =.021, two-way ANOVA). The treatment did not alter outcome or the duration of ICU stay. No serious side effects were detected.


CONCLUSIONS
GHB effectively controls AWS symptoms in medical ICU patients. The rapid initial treatment response of GHB in contrast to CLO has no influence on duration of patient withdrawal.
Elsing
Christoph
C
Department of Internal Medicine, St Elisabeth Hospital, Dorsten, Germany. c.elsing@krankenhaus-dorsten.de
Stremmel
Wolfgang
W
Grenda
Uwe
U
Herrmann
Thomas
T
D000328:Adult; D000437:Alcoholism / Q000188:drug therapy*; D002719:Chlormethiazole / Q000009:adverse effects / Q000627:therapeutic use*; D015897:Comorbidity; D005260:Female; D018757:GABA Modulators / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D006885:Hydroxybutyrates / Q000009:adverse effects / Q000627:therapeutic use*; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome
D018757:GABA Modulators; D006885:Hydroxybutyrates; D002719:Chlormethiazole; C111420:4-hydroxybutyric acid