Benzodiazepines for Alcohol Withdrawal in the Elderly and in Patients With Liver Disease

  title={Benzodiazepines for Alcohol Withdrawal in the Elderly and in Patients With Liver Disease},
  author={Michael P. Peppers},
  journal={Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy},
  • M. Peppers
  • Published 2 January 1996
  • Medicine
  • Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
Alcohol withdrawal syndrome (AWS) may result in nausea, vomiting, diarrhea, weakness, sweating, tremors, tachycardia, hypertension, agitation, delirium, hallucinations, seizures, and death beginning 6 hours after alcohol cessation in alcoholics. Benzodiazepines are cross‐tolerant with ethanol and are considered first‐line therapy for treating AWS. Chlordiazepoxide and diazepam are first metabolized by hepatic oxidation, then glucuronidation. Lorazepam and oxazepam undergo only hepatic… 
Inpatient Management of Acute Alcohol Withdrawal Syndrome
Alcohol withdrawal is a common condition encountered in the hospital setting after abrupt discontinuation of alcohol in an alcohol-dependent individual and management revolves around early identification of at-risk individuals and symptom assessment using a validated tool such as the revised Clinical Institute Withdrawal Assessment for Alcohol score.
Managing Alcohol Withdrawal in the Elderly
To ensure appropriate benzodiazepine treatment, dose and frequency should be individualised with frequent monitoring, and based on validated alcohol withdrawal severity measures, the age of the patient should not deter clinicians from helping the patient achieve successful alcohol treatment and rehabilitation.
Identification and Management of Alcohol Withdrawal Syndrome
The gold-standard treatment for AWS is with benzodiazepines, and drugs, such as α2-agonists (clonidine and dexmetedomidine) and β-blockers can be used as adjunctive treatments to control neuroautonomic hyperactivity.
Effect of variations in treatment regimen and liver cirrhosis on exposure to benzodiazepines during treatment of alcohol withdrawal syndrome
Differences in treatment regimens, the choice of BDZ, as well as the presence of liver cirrhosis can substantially alter the exposure of patients to drugs used for AWS treatment.
Recognition, Assessment, and Pharmacotherapeutic Treatment of Alcohol Withdrawal Syndrome in the Intensive Care Unit.
Alcohol withdrawal syndrome (AWS) is a complex neurologic disorder that develops after an acute reduction in or cessation of chronic alcohol consumption that alters neurotransmitter conduction. The
Levetiracetam for the Treatment of Alcohol Withdrawal Syndrome: A Multicenter, Prospective, Randomized, Placebo-Controlled Trial
Although tolerability and safety data were similar in the LV group when compared with placebo, the total daily and weekly dose of diazepam as rescue medication and the severity of alcohol withdrawal symptoms did not differ significantly between groups.
Benzodiazepine treatment for alcohol-dependent patients.
The clinical reality is that many alcoholics are treated by BZDs during detoxification and then continue to receive them for the treatment of anxiety disorders or insomnia, often secondary to alcohol dependence, and this review discusses the major indications for BZD treatment of alcoholism.
The alcohol withdrawal syndrome
Although AWS may be complex, careful evaluation and available treatments should ensure safe detoxification for most patients.
A Combination of Levetiracetam and Tiapride for Outpatient Alcohol Detoxification: A Case Series
Evidence is provided that the combination of levetiracetam and tiapride might be an effective and safe treatment option for mild to moderate AWS in outpatient settings, and further randomized controlled trials are warranted to confirm these preliminary results.
Inpatient alcohol withdrawal syndrome.


Disposition and Elimination of Minor Tranquilizers in the Aged and in Patients With Liver Disease
  • A. Hoyumpa
  • Medicine, Biology
    Southern medical journal
  • 1978
Based on pharmacokinetic data, oxazEPam and lorazepam would seem to be more suitable than diazepam and chlordiazepoxide for use in the elderly and in patients with liver disease.
Double-blind comparison of lorazepam and chlordiazepoxide in the treatment of the acute alcohol abstinence syndrome.
Because of its simpler and more predictable metabolic pathway and its insignificant accumulation in plasma during multiple-dose therapy, lorazepam may be the drug of choice if benzodiazepine therapy is required for chronic alcoholics with acute withdrawal symptoms.
Normal disposition of oxazepam in acute viral hepatitis and cirrhosis.
Unlike many other sedatives, oxazepam is eliminated normally in patients with parenchymal liver disease an therefore, on pharmacokinetic grounds, seems to be an excellent sedative for use in such persons.
Double-blind trial of alprazolam and chlordiazepoxide in the management of the acute ethanol withdrawal syndrome.
It was concluded that the choice between alprazolam and chlordiazepoxide for managing ethanol withdrawal should be based on criteria other than efficacy of control.
Halazepam in the management of acute alcohol withdrawal syndrome.
Efficacy evaluations indicated that halazepam was as effective as chlordiazepoxide in the control of symptoms in patients hospitalized for the medical management of acute alcohol withdrawal.
Acute Ethanol Poisoning and the Ethanol Withdrawal Syndrome
The initial evaluation of ethanol withdrawal requires taking a history of ethanol intake, assessment of severity of past withdrawal episodes and other drug intake, and a physical examination to evaluate potential coexisting illnesses.
The absorption of intramuscular chlordiazepoxide (Librium) in patients with severe alcoholic liver disease.
Because of the extremely slow intramuscular absorption of CDX dissolved in normal saline or the manufacturer's diluent in males with ALD, it is not recommend this route of administration in this population.
Comparative evaluation of treatments of alcohol withdrawal syndromes.
In a clinical comparative study, 49 patients were treated for the tremulous and agitated states and acute hallucinosis of alcohol withdrawal and paraldehyde with chloral hydrate was most effective and best tolerated.
Alcohol withdrawal seizures.
Inpatient management is desirable to eliminate other causes of seizures that occur for the first time in adult life and because such patients are at substantial risk for additional seizures and the development of delirium tremens.
Effects of aging and liver disease on disposition of lorazepam
It is concluded that the degree of impairment, if any, in the metabolism of lorazepam in patients with liver disease is considerably less than that of certain other drugs including related benzodiazepines.