Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond

Abstract

Alcohol dependence is an increasing and pervasive problem. Alcohol withdrawal symptoms are a part of alcohol dependence syndrome and are commonly encountered in general hospital settings, in most of the departments. Alcohol withdrawal syndrome ranges from mild to severe. The severe complicated alcohol withdrawal may present with hallucinations, seizures or delirium tremens. Benzodiazepines have the largest and the best evidence base in the treatment of alcohol withdrawal, and are considered the gold standard. Others, such as anticonvulsants, barbiturates, adrenergic drugs, and GABA agonists have been tried and have evidence. Supportive care and use of vitamins is essential in the management. Symptom triggered regime is favoured over fixed tapering dose regime, although monitoring through scales is cumbersome. This article aims to review the evidence base for appropriate clinical management of the alcohol withdrawal syndrome. We searched Pubmed for articles published in English on 'Alcohol withdrawal syndrome' in humans during the last 10 years. A total of 1182 articles came up. Articles not relevant to clinical utility and management were excluded based on the titles and abstract available. Full text articles, meta-analyses, systematic reviews and randomized controlled trials were obtained from this list and were considered for review.

Psychiatric Emergencies for Clinicians: Emergency Department Management of Alcohol Withdrawal

“…Many hospitals use symptomtriggered protocols in which benzodiazepines are administered based on standard withdrawal symptom scales, such as the CIWA-Ar (12). 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).…”

“…A history of complicated withdrawal is the most reliable risk factor for seizures or delirium. Other identified risk factors include older age, dehydration, comorbid medical illness or brain lesions, low platelet count, and hypokalemia (11,12). Persistent tachycardia and hyperthermia are associated with mortality (5).…”

Pharmacogenetic evaluation of adverse events’ risk in patients with alcohol withdrawal syndrome taking bromdihydrochlorphenylbenzodiazepine: The role of CYP2C19 gene polymorphisms

“…Бензодиазепиновые транквилизаторы -широко при-меняемые лекарственные средства (ЛС) в современной психиатрии, наркологии, неврологии, анестезиологии [1][2][3][4]. Клинический эффект бензодиазепинов реализуется путем взаимодействия с тормозными ГАМК-А-рецепторами в центральной нервной системе (ЦНС) [5][6][7].…”

“…Широкий терапевтиче-ский коридор дозировок бензодиазепиновых транквили-заторов создает мнимое впечатление, что данные ЛС прак-тически не представляют угрозы для пациента. Но спектр нежелательных побочных реакций (НПР) многократно опи-сан в литературе -это синдром отмены, развитие лекар-ственной зависимости, чрезмерной седации, гипотензии и падений, угнетения дыхания в сочетании с опиатами и барбитуратами, а также развитие обострений у пациентов с хронической обструктивной болезнью легких [3,6,9,10].…”

Using a personalized clinical decision support system for bromdihydrochlorphenylbenzodiazepine dosing in patients with anxiety disorders based on the pharmacogenomic markers

“…KEYWORDS alcohol withdrawal syndrome, benzodiazepines, clinical decision support system, CYP2C19, pharmacogenetics, tranquilizers 1 | INTRODUCTION Anxiety disorders are among the most prevalent psychiatric disorders comorbid with alcohol addiction (Bakken, Landheim, & Vaglum, 2005;Grant et al, 2004;Smith & Book, 2010). Benzodiazepines (BDZs) have the largest and the best evidence base in the treatment of alcohol withdrawal syndrome and are considered the gold standard (Sachdeva, Choudhary, & Chandra, 2015). These medications ameliorate or prevent the symptoms and complications of alcohol withdrawal (Weintraub, 2017).…”