A Comparative Study of Fixed Tapering Dose Regimen versus Symptom-triggered Regimen of Lorazepam for Alcohol Detoxification

Sachdeva, Ankur; Chandra, Manish; Deshpande, Smita N.

doi:10.1093/alcalc/agt181

Cited by 42 publications

(33 citation statements)

References 15 publications

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“…The second randomized controlled trial compared a fixed tapering dose regimen to a symptom-triggered regimen of lorazepam in men aged 18-60 years with AWS. 20 The use of the symptom-triggered regimen resulted in~10 mg less total lorazepam compared with the fixed tapering dose regimen overall (p<0.0001). In moderate AWS, 6.5 mg less total lorazepam was given with the symptom-triggered regimen (p=0.005), and 10.4 mg less was administered in severe AWS (p<0.001).…”

Section: Benzodiazepinesmentioning

confidence: 96%

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Management of Acute Alcohol Withdrawal Syndrome in Critically Ill Patients

et al. 2016

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Approximately 16-31% of patients in the intensive care unit (ICU) have an alcohol use disorder and are at risk for developing alcohol withdrawal syndrome (AWS). Patients admitted to the ICU with AWS have an increased hospital and ICU length of stay, longer duration of mechanical ventilation, higher costs, and increased mortality compared with those admitted without an alcohol-related disorder. Despite the high prevalence of AWS among ICU patients, no guidelines for the recognition or management of AWS or delirium tremens in the critically ill currently exist, leading to tremendous variability in clinical practice. Goals of care should include immediate management of dehydration, nutritional deficits, and electrolyte derangements; relief of withdrawal symptoms; prevention of progression of symptoms; and treatment of comorbid illnesses. Symptom-triggered treatment of AWS with γ-aminobutyric acid receptor agonists is the cornerstone of therapy. Benzodiazepines (BZDs) are most studied and are often the preferred first-line agents due to their efficacy and safety profile. However, controversy still exists as to who should receive treatment, how to administer BZDs, and which BZD to use. Although most patients with AWS respond to usual doses of BZDs, ICU clinicians are challenged with managing BZD-resistant patients. Recent literature has shown that using an early multimodal approach to managing BZD-resistant patients appears beneficial in rapidly improving symptoms. This review highlights the results of recent promising studies published between 2011 and 2015 evaluating adjunctive therapies for BZD-resistant alcohol withdrawal such as antiepileptics, baclofen, dexmedetomidine, ethanol, ketamine, phenobarbital, propofol, and ketamine. We provide guidance on the places in therapy for select agents for management of critically ill patients in the presence of AWS.

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Section: Benzodiazepinesmentioning

confidence: 96%

“…The second randomized controlled trial compared a fixed tapering dose regimen to a symptom‐triggered regimen of lorazepam in men aged 18–60 years with AWS . The use of the symptom‐triggered regimen resulted in ~10 mg less total lorazepam compared with the fixed tapering dose regimen overall (p<0.0001).…”

Section: Management Of Alcohol Withdrawal Syndromementioning

confidence: 99%

Management of Acute Alcohol Withdrawal Syndrome in Critically Ill Patients

et al. 2016

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“…Once stable, patients can be assessed every 4–8 h for additional therapy 3, 10. The symptom‐triggered approach is as efficacious as the fixed‐dose method in managing alcohol withdrawal in terms of efficacy and incidence of adverse events 77, 78. The advantages of symptom‐triggered therapy are shorter duration of detoxification, lower doses of BZD required, less sedation, and decreased risk of respiratory depression 3, 10, 77, 78, 79…”

Section: Therapymentioning

confidence: 99%

Alcohol withdrawal syndrome: mechanisms, manifestations, and management

et al. 2016

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The alcohol withdrawal syndrome is a well‐known condition occurring after intentional or unintentional abrupt cessation of heavy/constant drinking in patients suffering from alcohol use disorders (AUDs). AUDs are common in neurological departments with patients admitted for coma, epileptic seizures, dementia, polyneuropathy, and gait disturbances. Nonetheless, diagnosis and treatment are often delayed until dramatic symptoms occur. The purpose of this review is to increase the awareness of the early clinical manifestations of AWS and the appropriate identification and management of this important condition in a neurological setting.

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“…This approach improves recognition of alcohol withdrawal, reduces the amount of medication administered, and shortens the duration of withdrawal compared to a fixed dosing schedule (9). However, patients with a history of complicated withdrawal, who cannot tolerate elevated autonomic arousal, or for whom symptom-triggered management is infeasible should be provided a scheduled taper with additional coverage as symptoms warrant (21). Table 2 lists some published withdrawal protocols.…”

Section: What Key Findings Lead To the Diagnosis?mentioning

confidence: 99%