Which Benzodiazepine is best for alcohol withdrawal? Chlordiazepoxide vs. Diazepam.
Date First Published:
July 7, 2011
Last Updated:
July 11, 2011
Report by:
Fiona Reid, Medical Student (University of Manchester)
Search checked by:
Fiona Reid, University of Manchester
Three-Part Question:
In [patients though to be witdrawing from alcohol] is [Diazepam better than Chlordiazepoxide] at [treating alcohol withdrawal symptoms]?
Clinical Scenario:
Patient is in alcohol withdrawal. You want to know which is the best benzodiazepine to prescribe.
Search Strategy:
Ovid interface.
Medline 1948 to week 2 June 2011
{[exp.ethanol OR alcohol$.mp] AND [substance withdrawal syndrome.mp OR exp.substance withdrawal syndrome] OR [ex.alcohol withdrawal seizures OR aclohol withdrawal delerium OR alcoholic neuropathy] AND [exp.chlordiazepoxide OR librium.mp] AND [exp.diazepam]}LIMIT to english language AND human.
Embase 1980 to 2011 week 23.
{[exp.alcohol withdrawal OR exp.delirium tremens] AND [chlordiazepoxide OR librium] AND [diazepam]}LIMIT to english language AND human.
CINAHL 1994 to 2011
[alcohol withdrawal] AND [chlordiazepoxide OR librium] AND [diazepam]
Medline 1948 to week 2 June 2011
{[exp.ethanol OR alcohol$.mp] AND [substance withdrawal syndrome.mp OR exp.substance withdrawal syndrome] OR [ex.alcohol withdrawal seizures OR aclohol withdrawal delerium OR alcoholic neuropathy] AND [exp.chlordiazepoxide OR librium.mp] AND [exp.diazepam]}LIMIT to english language AND human.
Embase 1980 to 2011 week 23.
{[exp.alcohol withdrawal OR exp.delirium tremens] AND [chlordiazepoxide OR librium] AND [diazepam]}LIMIT to english language AND human.
CINAHL 1994 to 2011
[alcohol withdrawal] AND [chlordiazepoxide OR librium] AND [diazepam]
Outcome:
Medline found 26 articles, Embase found 155 articles and CINAHL found 16 articles. A Cochrane review was found to have reviewed all relevant papers up to 2010 and there have been no new studies completed since then.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Benzodiazepines for alcohol withdrawal. Amato, L; Minozzi, S; Vecchi, S; Davoli, M. 2010 Italy | Cochrane review- 64 studies with a totally of 4309 patients were reviewed. In the comparison between Diazepam and Chlordiazepoxide, 3 studies were found containing a total of 61 patients. | Cochrane review of randomised controlled trails. | Alcohol withdrawal seizure relative risk ratio (R.R)/ no. of events. Chlordiazepoxide vs. Diazepam. | 0.33 (0.01, 7.45)/ 0 vs. 1 | Very small number of patients studied. |
| CIWA-Ar score at 48 hours. Diazepam vs. Chlordiazepoxide. | MD -4.50 (-11.44 to 2.44) | ||||
| CIWA-Ar score at end of treatment. Diazepam vs. Chlordiazepoxide | MD -3.30 (-10.79 to 4.19) | ||||
| Adverse events as a no. of participants with at least one adverse event R.R/ no. of events. Chlordiazepoxide vs. Diazepam. | 3.00 (0.14 to 63.15)/ 1 vs. 0. | ||||
| Severe, life-threatening adverse events. Chlordiazepoxide vs. Diazepam. | None in either group. | ||||
| Drop out R.R./ no. of events. Chlordiazepoxide vs. Diazepam. | 6.00 (0.37 to 98.65)/ 4 vs. 0 | ||||
| Drop outs due to adverse events R.R/ no. of events. Chlordiazepoxide vs. Diazepam. | 3.00 (0.14 to 63.15) |
Author Commentary:
No statistically significant difference between the drug's performance.
Bottom Line:
Either drug could be used to treat alcohol withdrawal.
References:
- Amato, L; Minozzi, S; Vecchi, S; Davoli, M. . Benzodiazepines for alcohol withdrawal.