ALCOHOL-WITHDRAWAL - WHAT IS THE BENZODIAZEPINE OF CHOICE

OBJECTIVE: To review the literature concerning the use of benzodiazepi nes for treatment of alcohol withdrawal and to determine if the curren t literature assessment justifies the use of lorazepam as first-line t herapy. DATA SOURCES: A thorough review of the literature was performe d with an online database (BRS Colleague). Articles directed at the ta rgeted issue were chosen and additional references were obtained from the bibliographies of these articles. STUDY SELECTION: Clinical trials and case reports concerning the use of chlordiazepoxide, diazepam, an d lorazepam in alcohol withdrawal treatment were reviewed. DATA SYNTHE SIS: Lorazepam is considered by many to be the drug of choice for alco hol withdrawal because it undergoes glucuronidation and has an interme diate half-life. These characteristics have suggested its superiority when treating elderly patients or patients with liver disease. However , some studies suggest that a drug with a longer half-life would provi de smoother withdrawal. In addition, the number of patients with liver disease treated for alcohol withdrawal is unknown. These and other fa ctors question the recommendation of lorazepam as the drug of choice. CONCLUSIONS: Well-controlled comparison studies should be performed be fore recommending the routine use of lorazepam for treating alcohol wi thdrawal syndrome.