Tuesday, April 23, 2019

Treating Alcohol withdrawal - scheduled vs PRN benzodiazepines


Sometimes it's frustrating to see different physicians use different approaches to management of the same condition or disease. How do you practice in that case?

You look at the evidence, the guidelines and make your own decision based on it.

Then even though if your attending practices something opposite of what the guidelines say, you know what is right and what you will practice in the future :)

Anyway, now that I am done venting - what do guidelines say about scheduled vs as needed benzodiazepines for alcohol withdrawal?

As needed approach is better!

Multiple randomized and observational studies support this simple concept of giving the patient the therapy they need, only when they need it. Taken collectively, these studies demonstrate that symptom-triggered therapy achieves equivalent or superior clinical endpoints while requiring lower total doses of sedatives and shorter periods of hospitalization.

The landmark study of this approach is: Individualized Treatment for Alcohol Withdrawal: A Randomized Double-blind Controlled Trial. JAMA. 1994;272(7):519–523. doi:10.1001/jama.1994.03520070039035

101 patients admitted to an inpatient alcohol detoxification unit were randomly assigned to treatment with chlordiazepoxide using a fixed schedule or a symptom-triggered therapy. Patients in the symptom-triggered group required less medication (median 100 versus 425 mg) and a shorter treatment period (median 9 versus 68 hours) and had similar or better clinical outcomes.

So now you know :)


Source: UpToDate

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