Alcohol withdrawal syndrome

Intranasal Oxytocin Shows Promise for Alcohol Withdrawal.

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In a small pilot trial, the agent lowered withdrawal symptoms, anxiety, and the need for benzodiazepines.

Oxytocin blocks the development of tolerance and attenuates withdrawal symptoms in rodents. This double-blind, randomized study examined effects of oxytocin on alcohol withdrawal symptoms in humans.

The 11 actively drinking, alcohol-dependent participants (9 men; average age, 41) with a history of withdrawal symptoms but not of alcohol withdrawal seizures or delirium tremens underwent inpatient alcohol detoxification. Seven participants received intranasal oxytocin 24 IU twice daily for 3 days, and four received matching intranasal placebo. Lorazepam was given as needed, based on withdrawal symptoms. Oxytocin recipients required almost five times less lorazepam than the placebo recipients and had significantly lower withdrawal ratings on days 1 and 2 and anxiety/tension symptom ratings on day 2.

Comment: This very preliminary study suggests that oxytocin may reduce alcohol withdrawal symptoms in humans. Oxytocin would have advantages over benzodiazepines because it does not itself cause sedative-hypnotic tolerance and instead reverses it. However, oxytocin would be unlikely to prevent alcohol withdrawal seizures or delirium tremens.

Oxytocin has already been shown to reduce anxiety, increase interpersonal trust, and improve social cognition in humans, with no adverse effects, in short-term studies. Oxytocin is currently far from routine clinical use, but it will be exciting to see whether it can reduce drinking in alcohol-dependent outpatients or treat anxiety symptoms and disorders.

Source: Journal Watch Psychiatry

 

Symptom-Triggered Dosing Is Better Than Fixed Dosing for Treating Alcohol Withdrawal.

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Symptom-triggered dosing leads to lower total benzodiazepine dose and shorter hospital stay than fixed-tapered dosing.

In a retrospective chart review, researchers compared outcomes between 49 patients who received symptom-triggered benzodiazepine dosing and 50 who received standard fixed-tapered dosing for treatment of alcohol withdrawal in an emergency department (ED) clinical decision unit in Ireland during a 2-year period. Patients treated with the symptom-triggered dose regimen were assessed at 90-minute intervals using the Clinical Institute Withdrawal Assessment for Alcohol scoring tool and were given a dose of a benzodiazepine if the score indicated need. Patients treated with the standard regimen received tapered doses of benzodiazepine over 5 to 7 days. Benzodiazepine doses were reported in diazepam dosing equivalents, with 25 mg of chlordiazepoxide considered equivalent to 10 mg of diazepam.

The two groups were comparable in demographics, alcohol use, and reasons for coming to the ED. The symptom-triggered dosing group had a shorter median hospital stay (2 days vs. 3 days) and received a lower median cumulative benzodiazepine dose (equivalent to 80 mg vs. 170 mg of diazepam).

Comment: Many emergency physicians have already adopted the practice of treating alcohol withdrawal based on symptoms with the goal of the patient being calm but able to be aroused. This study suggests that this approach may not only reduce the amount of benzodiazepine needed, but it may also shorten hospital stay.

Source: Journal Watch Emergency Medicine