Treatment of alcohol withdrawal: tiapride and carbamazepine versus clomethiazole.

Abstract

In Germany, clomethiazole (CLO) and benzodiazepines are predominantly used as therapeutic agents in the treatment of the alcohol withdrawal syndrome (AWS). These agents have disadvantages such as sedation, risk of respiratory insufficiency, and cardiovascular complications as well as addictive potential. Alternatively, it could be demonstrated that both tiapride (TIA) and carbamazepine (CBZ) are efficient in the treatment of AWS with less toxicity. However, they seem to be less effective in AWS than CLO as single agents. But no systematic comparison of the combination of TIA and CBZ against an established therapeutic standard can be found in the literature. Therefore, we compared the combination of TIA and CBZ with CLO in two open exploratory studies with matched samples. Outcome parameters were heart rate, blood pressure, complications, withdrawal symptoms (CIWA-Ar scale), and general clinical state (CGI scale). A retrospective evaluation of medical records (30 TIA+CBZ, 30 CLO) was followed by an open prospective study (40 TIA+CBZ, 40 CLO). Both studies revealed similar efficacy in terms of psychopathologic and vegetative symptoms. Vegetative recovery seems to be faster with TIA+CBZ. Results of this exploratory study have to be confirmed by a controlled double-blind study with severity of AWS as an experimental factor.

Alcohol withdrawal delirium - diagnosis, course and treatment

“…The administration of both clomethiazole and benzodiazepines must be short-term, with gradual dose reduction after a steady state is achieved; in benzodiazepines, approximately to 15-20% of the total dose a day 36 . Some studies comparing clomethiazole with benzodiazepines showed its effectiveness and some of them reported shortening and generally better tolerance of treatment as well 69,86,87 .…”

“…The anticonvulsants of non-benzodiazepine type carbamazepine and oxcarbazepine with likely GABA-ergic and NMDA-blocking activity represent other drugs of possible use 87,95,96 . Carbamazepine has been used for over 30 years to treat alcohol withdrawal as a non-addictive, nonsedating agent reducing alcohol withdrawal symptoms 52,87 .…”

“…Carbamazepine has been used for over 30 years to treat alcohol withdrawal as a non-addictive, nonsedating agent reducing alcohol withdrawal symptoms 52,87 . The newer anticonvulsant oxcarbazepine, a structurally modified carbamazepine, does not carry carbamazepine's side-effects of active metabolites.…”

The Pharmacology of Chlormethiazole: A Potential Neuroprotective Agent?

“…Its inhibitory effects are exerted by postsynaptic receptors that are coupled directly to anion channels (GABA A ) and also by presynaptic G-protein coupled receptors (GABA B ). Extracellular recordings of cultured animal neurons have shown that CMZ is capable of potentiating the inhibitory effects of GABA and muscimol (a specific GABA A agonist) (9). CMZ does not alter levels of inhibitory neuropeptide within the brain but can modulate its actions.…”

Estrategias en el tratamiento de desintoxicación alcohólica

“…Desde el punto de vista del tratamien-to del SAA presenta los siguientes efectos terapéuti-cos: ansiolisis a través de mecanismo desconocido, alivia el sufrimiento psíquico, disminuye trastornos del sistema nervioso autónomo así como el insomnio; asimismo, mejora la abstinencia alcohólica (65) . En un estudio piloto reciente se muestra que aunque tiapride por sí solo no sea tan eficaz como clometiazol, sin embargo en combinación con carbamacepina es igualmente eficaz e incluso superior en el tratamiento de síntomas vegetativos (66) .…”