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Determinants of success of loading dose diazepam for alcohol withdrawal: A chart review

Journal of Pharmacology and Pharmacotherapeutics
Medknow Publications
Publication Date
DOI: 10.4103/0976-500x.99440
  • Research Letters


Sir, The use of loading dose diazepam for the treatment of alcohol withdrawal was first described by Sellers et al.[1] The same was used successfully in Indian patients by Manikant et al.[2] It involves the administration of 20mg oral diazepam every 2 h until the patient is drowsy, but arousable. Symptoms of alcohol withdrawal are monitored using the Clinical Institutes Withdrawal Assessment for Alcohol - Revised (CIWA-Ar) scale.[3] Further doses are withheld whenever CIWA-Ar scores fall below 8. The major advantages of this method include faster recovery from delirium, lower total doses of diazepam and a lesser risk of complications like withdrawal seizures and arrhythmias. We use loading dose diazepam to treat alcohol withdrawal in our in-patient de-addiction unit at JIPMER. A chart review involving 25 consecutive admissions of alcohol use disorders between 1st August and 15th November, 2011 was conducted. The goals of the review were to identify the following: 1)The success of loading dose diazepam in the treatment of the alcohol withdrawal state; and2)The clinical variables that determine the success or failure of loading dose regimen.“Successful treatment” was defined as follows: a)Resolution of delirium within 24 h; orb)The ability to prevent any complications like seizures or delirium after admission in patients who presented with severe but uncomplicated withdrawal. As noted in Figure 1, out of the 25 admissions, 15 patients (60%) had significant withdrawal symptoms at admission (CIWA-Ar > 8). Nine (60%) of them had a complicated withdrawal state at presentation (one with seizures alone, three with withdrawal seizures and delirium and five with delirium alone). Figure 1 Number of patients admitted and given loading dose diazepam In six out of fourteen (42.85%) patients given loading dose diazepam, it was successful. Four of them did not have any comorbid illness. One was hypertensive. One had panic disorder. None of them had hepatic,

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