Pharmacologic Treatment of Alcohol Withdrawal

James R. Johnson, MD
JAMA. 1997;278(16):1317. doi:10.1001/jama.1997.03550160037025.
Text Size: A A A
Published online

To the Editor.  —The conclusion from the meta-analysis by Dr Mayo-Smith and colleagues1 that benzodiazepines are more effective than placebo in preventing delirium among patients withdrawing from alcohol is not convincingly supported by the data. First, chlordiazepoxide was the only benzodiazepine studied for its effect on delerium in the 4 placebo-controlled trials included in the meta-analysis. Although it is tempting to extrapolate from chlordiazepoxide to other benzodiazepines, the differences noted between different drugs in this class with respect to other aspects of alcohol withdrawal therapy (eg, oversedation and breakthrough of withdrawal symptoms) caution that an assumption of equivalence for delirium control may need empirical validation.Second, the appropriateness of pooling the 4 studies for meta-analysis seems questionable in view of the studies' disparate findings. Three of the studies essentially suggested equivalence between placebo and chlordiazepoxide with respect to the proportion of patients with delirium (combined: 3/56 [placebo] vs 2/69


Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.