BETA-CARBOLINES IN ALCOHOL-DEPENDENT INTENSIVE-CARE PATIENTS DURING PROPHYLACTICS AND THERAPY OF ALCOHOL-WITHDRAWAL SYNDROME

The primary aim of this study was to investigate whether the naturally occurring beta-carbolines norharman and harman differed between alcoh ol-dependent patients who developed alcohol withdrawal syndrome (AWS) and those who did not. The secondary aim was to determine whether diff erent treatment regimens influenced the levels of the beta-carbolines. Thirty chronic alcoholics with carcinoma of the upper digestive tract were included in this study. They were prophylactically treated by tw o different medical regimens: flunitrazepam and clonidine (FNZ regimen ) and gamma-hydroxybutyrate and clonidine (GHB regimen). Patients exce eding the Revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar) score of 20 were assigned to the AWS therapy group an d received haloperidol in addition to their previous prophylactic trea tment. Patients without AWS remained in the prophylactic group. From d ays 1-4 of the intensive cave unit (ICU) stay norharman, but not harma n, was increased in the AWS therapy group In the FNZ regimen, six of 1 6 patients (38%) and in the GHB regimen, nine of 14 patients (64%) dev eloped AWS (p = 0.14). Norharman levels did not differ between the two regimens. However, harman levels were increased in the GHB treated re gimen on days 1, 2 and 4 following admission to the ICU and correlated with the severity of alcohol withdrawal syndrome. As norharman was el evated in the therapeutically treated ICU patients, this marker appear s to be involved in the pathogenesis of AWS. As harman was elevated be fore and during hallucinations on the GHB regimen, it seems reasonable to carry out further investigations into the potential role of harman as a hallucinatory substance.