A Cochrane review «Benzodiazepines for alcohol withdrawal»1 «Amato L, Minozzi S, Vecchi S, Davoli M. Benzodiazepines for alcohol withdrawal. Cochrane Database Syst Rev 2010;(3):CD005063. .»1 included 64 studies with a total of 4 309 subjects. Benzodiazepines offered a large benefit against alcohol withdrawal seizures compared to placebo (RR 0.16, 95% CI 0.04 to 0.69; 3 studies, n=324). There were no statistically significant differences when benzodiazepines were compared with other drugs for seizure (RR 0.52, 95% CI 0.21 to 1.31; 12 studies, n=1228) and delirium control (RR 0.65, 95% CI 0.21 to 1.98, statistical heterogeneity I2=52%; 8 studies, n=893), severe life threatening side effect (RR 1.95, 95% CI 0.25 to 15.28; 7 studies, n=340), dropouts (RR 0.93, 95% CI 0.70 to 1.24; 22 studies, n=1848), dropouts due to side effects (RR 0.82, 95% CI 0.23 to 2.88; 8 studies, n=533) and patient's global assessment score (RR 1.04, 95% CI 0.97 to 1.12; 2 studies, n=140). A trend in favour of other drug group was observed for CIWA-Ar scores at 48 hours and at the end of treatment; the results reached statistical significance only in one study (results on Hamilton anxiety rating scale favoured other drug group, MD -1.60, 95% CI -2.59 to -0.61; 1 study, n=43).
There were no statistically significant differences when different benzodiazepines were compared among themselves, although chlordiazepoxide seemed to perform better than other benzodiazepines. Three studies (n=262) compared fixed versus symptom-triggered schedules of a benzodiazepine (chlordiazepoxide, oxazepam, flunitrazepam) for various outcomes. There was a small significant benefit of symptom-triggered regimens regarding CIWA-Ar score (change from baseline) at 48 hrs (MD -5.70, 95% CI -11.02 to -0.38; 1 study, n=44). No other statistically significant differences were found.
Another Cochrane review «»2 «Amato L, Minozzi S, Davoli M. Efficacy and safety of pharmacological interventions for the treatment of the Alcohol Withdrawal Syndrome. Cochrane Database Syst Rev 2011;(6):CD008537. »2 included 114 studies with a total of 7333 participants. Comparing each of the five treatments versus specific class of drugs, benzodiazepines performed better than antipsychotics for seizures (RR 0.24, 95% CI 0.07 to 0.88; 4 studies, n=633.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) but upgraded by large magnitude of effect.
The following decision support rules contain links to this evidence summary: