Binds to GABAA enhancing GABA activity (requires GABA to be present)
Increases the frequency of GABAA receptor channel opening
Common agents: lorazepam, chlordiazepoxide, diazepam
Depends on agent, higher doses than used for sedation
Onset: 2-10 minutes
Metabolism: Hepatic and substrate of CYP isoenzymes
Elimination: primary through urine as metabolites
Equivalent Dose (mg)
Onset of Action
Should we do symptom-triggered or fixed dosing of benzodiazepines?
Saitz et al. Individualized Treatment for Alcohol Withdrawal: A Randomized Double-blind Controlled Trial
To assess the effect of an individualized treatment regimen on the intensity and duration of medication treatment for alcohol withdrawal.
A randomized double-blind, controlled trial
An inpatient detoxification unit in a Veterans Affairs medical center.
Fixed-schedule: Chlordiazepoxide four times daily +PRNs vs Symptom triggered therapy: Chlordiazepoxide only in response to signs and symptoms of alcohol withdrawal
The median duration of treatment in fixed-schedule 68 hr vs 9 hr in symptom-triggered group (P<.001)Mean dose 425 mg vs 100 mg (P<.001)No significant differences in the severity of withdrawal, the incidence of seizures, or delirium tremens.
Symptom-triggered therapy individualizes treatment, decreases both treatment duration and the amount of benzodiazepine used, and is as efficacious as standard fixed-schedule therapy for alcohol withdrawal.
American Society of Addiction Medicine
Sedative hypnotic drugs are recommended as the primary agents for managing AWD (grade A recommendation)
There isn’t evidence that one sedative-hypnotic agent that is superior to others or that switching from one to another is helpful.
Dose agents to achieve light sedation (grade C recommendation).
The patient is awake but tends to fall asleep unless stimulated
Adrenergic antagonists may be considered as adjunction (grade C recommendation)
For control of persistent hypertension or tachycardia
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