Alcohol Withdrawal: Medications Comparison
|Onset of Action||Oral: ~30 min||Oral (Rapid) and IV (Immediate)||Oral (60 min) and IV (~20 min)||Slowest|
|Half Life||Long (24-48 hr)||Long (20-50 hr)||Short (10-20 hr)||Short (3-20 hr)|
|Reducing Breakthrough Symptoms||Yes||Yes||No||No|
|Equivalent Doses (to 10 g alcohol)||25 mg||5 mg||1 mg||15 mg|
|Pregnancy||Positive evidence of risk to human fetus||Positive evidence of risk to human fetus||Positive evidence of risk to human fetus||Positive evidence of risk to human fetus|
1. Longer duration of action (active metabolites) of Chlordiazepoxide and Diazepam may decrease rate of breakthrough symptoms and have an added auto- tapering effect.
2. Longer onset of action of Lorazepam may lead to iatrogenic over-sedation if titrated too rapidly.
When is Lorazepam preferred over Diazepam?
- Hepatic dysfunction (INR > 1.6)
- Renal dysfunction (CrCl < 30 ml/min, Scr > 2 mg/dL)
- Age > 65 years.
What is the Role of Topiramate in Alcohol Withdrawal Management?
Topiramate, within the dosage range of 75-300 mg/day, could be considered as a first-line treatment option for the management of Alcohol Use Disorder. Its use appears to be safe and well-tolerated, especially in light of very recent findings.
Furthermore, Topiramate considerably helps to abstain from drinking during the first 16-week post-detoxification period.
But does Topiramate helps in Acute Alcohol Withdrawal Period?
Please do post your questions or comments below.
Dr. Harvinder Singh, M.D. (Admin)
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