Which Benzodiazepine is best for alcohol withdrawal? Chlodiazepoxide vs. Lorazepam.
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 [adults thought to be withdrawing from alcohol] is [Lorazepam better than Chlordiazepoxide] at [treating alcohol withdrawal symptoms]
Clinical Scenario:
Patient is experiencing symptoms of alcohol withdrawal. You want to know which is the best benzodiazepine to give.
Search Strategy:
Ovid interface.
Medline 1948 to week 2 June 2011.
{[exp.ethanol OR alcohol$.mp] AND [substance withdrawal syndrome.mp OR exp.substance withdrawal syndrome] OR [ex.alcohol withdrawal seizures OR aclohol withdrawal delerium OR alcoholic neuropathy] AND [exp.chlodiazepoxide OR librium.mp] AND [exp.lorazepam]}LIMIT to english language AND human.
Embase 1980 to 2011 week 23
{[exp.alcohol withdrawal OR exp.delirium tremens] AND [exp.chordiazepoxide OR librium.mp] AND [exp.lorazepam]}LIMIT to english language AND human.
CINAHL 1994-2011
[alcohol withdrawal] AND [chlordiazepoxide OR librium] AND [lorazepam]
Medline 1948 to week 2 June 2011.
{[exp.ethanol OR alcohol$.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.chlodiazepoxide OR librium.mp] AND [exp.lorazepam]}LIMIT to english language AND human.
Embase 1980 to 2011 week 23
{[exp.alcohol withdrawal OR exp.delirium tremens] AND [exp.chordiazepoxide OR librium.mp] AND [exp.lorazepam]}LIMIT to english language AND human.
CINAHL 1994-2011
[alcohol withdrawal] AND [chlordiazepoxide OR librium] AND [lorazepam]
Outcome:
Medline had 15 articles, Embase had 127 articles and CINAHL had 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. The comparison of Chlordiazepoxide an Lorazepam only contained two reviews, one of 100 patients, the other with 50 patients. | Cochrane systematic review of randomised controlled trails. | Alcohol withdrawal seizure relative risk ratio (R.R)/ no. of events: chlordiazepoxide vs. lorazepam | 0.20 (0.01, 3.97)/ 0 vs. 2 | Small numbers in each group. |
| Alcohol withdrawal delirium relative risk/ no. of events: lorazepam vs. chlordiazepoxide. | 0.33 (0.01, 7.99) / 0 vs. 1 | ||||
| CIWA-Ar score at 48 hours: lorazepam vs. chlordiazepoxide. | MD 0.00 (-0.06, 0.06) | ||||
| CIWA-Ar score at end of treatment. lorazepam vs. chlordiazepoxide. | MD 0.00 (-0.51, 0.51) | ||||
| Adverse events as a no. of participants with at least one adverse event R.R/ no. of events. lorazepam vs. chlordiazepoxide. | 2.00 (0.19, 21.36) 2 vs. 1 | ||||
| Drop outs R.R./ no. of events. lorazepam vs. chlordiazepoxide. | 0.75 (0.24, 2.37) 7 vs. 9 | ||||
| Drop outs due to adverse events. lorazepam vs. chlordiazepoxide. | None in either group. |
Author Commentary:
No statistically significant difference in drugs performance.
Bottom Line:
Could use either drug to control symptoms.
References:
- Amato, L; Minozzi, S; Vecchi, S; Davoli, M.. Benzodiazepines for alcohol withdrawal.