title: Effect of variations in treatment regimen and liver cirrhosis on exposure to benzodiazepines during treatment of alcohol withdrawal syndrome.
abstract: OBJECTIVE
  Benzodiazepines (BDZs) are the drugs of choice to prevent the symptoms of alcohol withdrawal syndrome (AWS). Various treatment protocols are published and have been shown to be effective in both office-managed and facility-managed treatment of AWS. The aim of this scientific commentary is to demonstrate the differences in the expected exposure to BDZs during AWS treatment using different treatment regimens available in the literature, in patients with or without alcoholic liver cirrhosis.
  
  
  METHODS
  Diazepam and lorazepam AWS protocols were examined and reviewed in the literature, and blood plasma levels were examined and compared, respectively.
  
  
  RESULTS
  Considerable variation in the blood levels with the different dosing schedules was found. Because the drugs are metabolized differently, we have also shown that liver disease affects the blood levels of diazepam, but not of lorazepam.
  
  
  CONCLUSIONS
  Differences in treatment regimens, the choice of BDZ, as well as the presence of liver cirrhosis can substantially alter the exposure of patients to drugs used for AWS treatment. Outpatient treatment of AWS has been shown to be relatively safe and effective for the treatment of AWS but patients should be carefully monitored.
authors: School of Pharmacy, University of Nottingham, University Park, Nottingham, UK;
authors: Pavel
authors: P
authors: Gershkovich
authors: College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada;
authors: Kishor M
authors: KM
authors: Wasan
authors: College of Pharmacy, University of Montpellier 1, Montpellier, France;
authors: Charles
authors: C
authors: Ribeyre
authors: Pfizer Global Research and Development, Groton Labs, Groton, CT, USA;
authors: Fady
authors: F
authors: Ibrahim
authors: Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
authors: John H
authors: JH
authors: McNeill
keywords: alcohol withdrawal; area under curve; benzodiazepines; cirrhosis; clearance; metabolism; outpatients; pharmacokinetics