Symptom-Triggered vs Fixed-Schedule Doses of Benzodiazepine for Alcohol Withdrawal

Overall Study Question

These investigators evaluated the benefit of using a symptom-triggered versus fixed-schedule doses of benzodiazepines for the prevention of alcohol withdrawal.

Patients

117 patients with alcohol dependence who were entering an alcohol dependence program. Their average age was 47 and 77% were male.

Treatment

Patients were randomized to a fixed schedule of oxazepam 30 mg Q6H for 4 doses followed by 15 mg PO Q6H for 8 doses or a symptom triggered dose (Clinical Institute Withdrawal Assessment for Alcohol scale*) which included a placebo given in a similar regimen as the fixed schedule group plus doses (15-30 mg) of oxazepam as needed based on an alcohol withdrawal scale.

* patients with scores between 8 and 15 received 15 mg of oxazepam, and those with a score higher than 15 received 30 mg of oxazepam

Duration

4 days.

Results

Patients who received oxazepam (%) Average total dose of oxazepam (mg) As needed oxazepam (mg) Total # of seizures Hallucinations, DT’s QOL, well being
Fixed schedule (n=61) 100 231 7 0 0 NSS
Symptom based (n=56) 39 38 38 1 0

How does this study contribute to the use of benzodiazepines in the prevention of alcohol withdrawal?

This study shows that treatment of patients who are at risk for alcohol withdrawal do as well on a symptom-triggered regimen of oxazepam as on a fixed-dose schedule. The total amount of oxazepam used is lower in the symptom-triggered group.

Original Citation

Daeppen JB, Gache P, Landry U, Sekera E, Schweizer V, Gloor S, Yersin B. Symptom-triggered vs fixed-schedule doses of benzodiazepine for alcohol withdrawal: a randomized treatment trial. Arch Intern Med 2002;162:1093-4

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