This pilot study evaluates the safety and efficacy of divalproex sodium (Depakote) for alcohol withdrawal and relapse prevention. Sixteen patients in moderate alcohol withdrawal were randomized to receive a standard benzodiazepine detoxification, depakote detoxification, or depakote detox plus maintenance. Symptom reduction occurred more rapidly and consistently in the depakote treated patients than in the benzodiazepine control group, and at six-week follow up a greater percentage of patients in the depakote maintenance group were completely abstinent than either detox-only group. There were no significant differences in sociodemographic or drinking data amongst the three cohort samples at baseline. Our findings suggest that the anticonvulsant divalproex sodium (Depakote) may be a safe and efficacious alternative to benzodiazepines for the treatment of alcohol withdrawal. It may be an advantageous alternative for outpatient detoxification, as it has no abuse potential, pharmacologic synergy with alcohol, or substantial cognitive or psychomotor side effects.
This clinical trial did not find evidence of efficacy for acamprosate compared to placebo among alcohol-dependent individuals recruited primarily by advertisement as studied in a primary care setting. Drinking outcomes significantly improved regardless of medication condition. A goal of abstinence was significantly associated with improved drinking outcomes, suggesting that alcohol-dependent patients with such a goal may do particularly well with counseling in a family medicine setting.
Sir: Several cases have been reported of lithium neurotoxicity when antibiotics are added to lithium therapy. Spectinomycin, 1 metronidazole, 2 and tetracyclines 3,4 have been reported to increase serum lithium concentrations in the abovementioned cases. Here we report a first case of severe lithium neurotoxicity induced by possible interaction between lithium and levofloxacin, a fluoroquinolone.Case report. Mr. A, a 56-year-old man with mild mental retardation, had been treated for DSM-IV bipolar I disorder for 5 years. His affective symptoms had been well maintained on a regimen of lithium carbonate, 1200 mg/day, and chlorproma-
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