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Front-loaded diazepam versus lorazepam for treatment of alcohol withdrawal agitated delirium.

Authors
  • Levine, Alexander R1
  • Thanikonda, Varshitha2
  • Mueller, Jane3
  • Naut, Edgar R4
  • 1 Department of Pharmacy Practice, University of Saint Joseph School of Pharmacy & Physician Assistant Studies, Hartford, Connecticut, United States of America; Clinical Pharmacist, Department of Pharmacy, Saint Francis Hospital and Medical Center, Hartford, Connecticut, United States of America. Electronic address: [email protected] , (United States)
  • 2 UConn Health, Farmington, Connecticut, United States of America. , (United States)
  • 3 Clinical Pharmacist, Department of Pharmacy, Saint Francis Hospital and Medical Center, Hartford, Connecticut, United States of America. , (United States)
  • 4 UConn Health, Farmington, Connecticut, United States of America; Department of Medicine, Hartford, Connecticut, United States of America. , (United States)
Type
Published Article
Journal
The American journal of emergency medicine
Publication Date
Jun 01, 2021
Volume
44
Pages
415–418
Identifiers
DOI: 10.1016/j.ajem.2020.04.095
PMID: 32402500
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Front-loaded diazepam is used to rapidly control agitation in patients with severe alcohol withdrawal syndrome (AWS). Our institution began using front-loaded lorazepam in August 2017 secondary to a nation-wide shortage of intravenous (IV) diazepam. Currently, there are no studies comparing lorazepam to diazepam for frontloading in severe AWS. Retrospective cohort study of all adults presenting to the emergency department with a diagnosis of AWS and prescribed the institution's alcohol withdrawal agitated delirium protocol 8 months pre and post shortage of IV diazepam were eligible inclusion for the study. Of these, 106 patients were front-loaded with diazepam and 70 patients were front-loaded with lorazepam. There was no difference in the mean change in Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised scores 24 h pre and post front-loading in the two groups (-13.9 ± -8.08 vs. -13.1 ± -8.91, p = 0.534). Patients who received front-loaded lorazepam had an increased incidence of ICU-delirium (positive for the Confusion Assessment Method in the ICU: 75% with lorazepam vs. 52.6% with diazepam, p = 0.009) and a higher risk of over-sedation, but this did not reach statistical significance (Richmond Agitation-Sedation Scale score < -1: 32.1% with lorazepam vs. 18.2% with diazepam, p = 0.063). Front-loaded lorazepam was similar to front-loaded diazepam in controlling AWS symptoms. Lorazepam's delayed onset of action should be considered when determining how quickly repeat doses are administered to avoid the potential for adverse drug events. Copyright © 2020. Published by Elsevier Inc.

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