Alcohol Withdrawal: Medications Comparison

Alcohol Withdrawal: Medications Comparison

 

  Chlordiazepoxide Diazepam  Lorazepam Oxazepam
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)
Active Metabolites Yes Yes No No
Reducing Breakthrough Symptoms Yes Yes No No
Hepatic metabolism 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

 

Clinical Tip:

 

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?

    • COPD
    • 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?

 

Source:

Ind Psychiatry J. 2013 Jul-Dec; 22(2): 100–108.

CNS Drugs. 2015 May;29(5):383-95.

BMC Psychiatry. 2011 Mar 14;11:41.

Please do post your questions or comments below. 


Dr. Harvinder Singh, M.D. (Admin)


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Responses

  1. Good article. However, there’s increased evidence that Topiramate is effective in widthdrawal symptoms too. it inhibits noradrenaline released by the neurons at the locus caeruleous.

      1. 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.
        Source: CNS Drugs. 2015 May;29(5):383-95.

        Furthermore, Topiramate considerably helps to abstain from drinking during the first 16-week post-detoxification period.
        Source: BMC Psychiatry. 2011 Mar 14;11:41.

        But Does Topiramate helps in Acute Alcohol Detoxification Period?

Comments are closed.