Gamma-hydrobutyric acid (GHB) in the treatment of alcohol withdrawal syndrome: A randomized comparative study versus benzodiazepine

Background: Benzodiazepine has been shown to be one of the most effective c lass of drugs in the management of alcohol withdrawal syndrome (AWS). Gamma -hydroxybutyric acid (GHB) has recently been introduced in the treatment of alcohol problems, including AWS. At present there are no comparative studi es between benzodiazepines and GHB in AWS treatment. The aim of the present randomized, controlled, single-blind study was to evaluate the efficacy an d safety of GHB compared with diazepam in the treatment of AWS. Methods: Sixty alcoholics affected by AWS were enrolled in the study. Diaze pam (0.5-0.75 mg/kg body weight for 6 days, tapering the dose 25% daily unt il day 10) was administered orally to 30 patients (25 males, 5 females; mea n age 44.3 +/- 10.9 years); GHB (50 mg/kg body weight for 10 days) was admi nistered orally to 30 patients (26 males, 4 females; mean age 41.7 +/- 10.4 years). The Clinical Institute Withdrawal Assess ment for Alcohol-revised scale (CIWA-Ar) was used to evaluate the AWS physical symptoms. The State A nxiety Inventory test for current anxiety assessment and the Zung self-rati ng Depression Scale for current depression assessment were performed. Results: Eight patients (26.6%) in the diazepam group and 4 patients (13.3% ) in the GHB group dropped out. Both treatments were effective in reducing AWS. No significant difference was found between the groups in CIWA-Ar tota l score at baseline and at the different times of observation. Considering the CIWA-Ar subscore and Zung scale, a significant reduction of anxiety on day 4 (p < 0.02), agitation on day 5 (p < 0.02) and time of recovery of dep ression on day 5 (p < 0.02) was observed in the GHB group with respect to t he diazepam group. Drowsiness and vertigo developed after initial drug admi nistration in the GHB (19.2%) and diazepam (36.4%) groups and quickly resol ved in both groups. Conclusions: GHB is as effective in the management of AWS as benzodiazepine and it seems to be quicker in reducing anxiety, agitation, and depression. Both drugs are safe and well-tolerated in AWS management.