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July 9, 1997, Vol 278, No. 2 >
ARTICLE | July 9, 1997

Pharmacological Management of Alcohol Withdrawal: Title and subTitle BreakA Meta-analysis and Evidence-Based Practice Guideline FREE

Michael F. Mayo-Smith, MD, MPH
[+] Author Affiliations

A complete list of the members of the Working Group on Pharmacological Management of Alcohol Withdrawal appears at the end of this article.

Reprints: California Society of Addiction Medicine, 3803 Broadway, Oakland. CA 94611-5615.


JAMA. 1997;278(2):144-151. doi:10.1001/jama.1997.03550020076042
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References

Objective.  —To provide an evidence-based practice guideline on the pharmacological management of alcohol withdrawal.

Data Soureces.  —English-language articles published before July 1, 1995, identified through MEDLINE search on "substance withdrawal—ethyl alcohol" and review of references from identified articles.

Study Selection.  —Articles with original data on human subjects.

Data Abstraction.  —Structured review to determine study design, sample size, interventions used, and outcomes of withdrawal severity, delirium, seizures, completion of withdrawal, entry into rehabilitation, adverse effects, and costs. Data from prospective controlled trials with methodologically sound end points corresponding to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, were abstracted by 2 independent reviewers and underwent meta-analysis.

Data Synthesis.  —Benzodiazepines reduce withdrawal severity, reduce incidence of delirium (-4.9 cases per 100 patients; 95% confidence interval, -9.0 to -0.7; P=.04), and reduce seizures (-7.7 seizures per 100 patients; 95% confidence interval, -12.0 to -3.5; P=.003). Individualizing therapy with withdrawal scales results in administration of significantly less medication and shorter treatment (P<.001). β-Blockers, clonidine, and carbamazepine ameliorate withdrawal severity, but evidence is inadequate to determine their effect on delirium and seizures. Phenothiazines ameliorate withdrawal but are less effective than benzodiazepines in reducing delirium (P=.002) or seizures (P<.001).

Conclusions.  —Benzodiazepines are suitable agents for alcohol withdrawal, with choice among different agents guided by duration of action, rapidity of onset, and cost. Dosage should be individualized, based on withdrawal severity measured by withdrawal scales, comorbid illness, and history of withdrawal seizures. β-Blockers, clonidine, carbamazepine, and neuroleptics may be used as adjunctive therapy but are not recommended as monotherapy.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

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