A Randomized Comparison of Lorazepam and Chlordiazepoxide in Patients With Uncomplicated Alcohol withdrawal
Vishnu Gade1, Lokesh Kumar Kalasapati2, Ravali Reddy Kadari3, Nidhi Tiyyagura3, Pramod K R Mallepalli4, CM Pavan Kumar5
1 Senior Resident, Department of Psychiatry, Mamata Medical College, Khammam, Telangana, India
2 Assistant Professor, Department of Psychiatry, Bhaskar Medical College, Hyderabad, Telangana, India
3 Intern, Department of Psychiatry, Mamata Medical College, Khammam, Telangana, India
4 Professor& Head, Department of Psychiatry, Mamata Medical College, Khammam, Telangana, India
5 Professor & Head, Department of Psychiatry, Shadan Institute of Medical Sciences, Hyderabad, India
# 4-1-1083, Sri Vishnu Nivas, Boggulkunta, Abids, Hyderabad-500001 Telangana
Source of Support: None, Conflict of Interest: None
Background: Lorazepam (Ativan) and Chlordiazepoxide (Librium) are both popular treatments for alcohol-withdrawal syndrome. Nevertheless, there is little literature directly comparing the two drugs
Aim: To compare the efficacy of Lorazepam and Chlordiazepoxide in the treatment of patients experiencing symptoms of acute alcohol withdrawal.
Methodology: Sixty consecutive consenting male inpatients in a state of moderately severe, uncomplicated alcohol withdrawal at screening, based on the inclusion criteria, were randomized to receive either Lorazepam (8 mg/day) or Chlordiazepoxide (200 mg/day) with dosing down-titrated to zero in a fixed-dose schedule across 8 treatment days. Severity of alcohol dependence was measured using Severity of Alcohol Dependence Questionnaire (SADQ). The initial withdrawal assessment and subsequent progress of withdrawal were assessed using Clinical Institute Assessment for Alcohol-revised (CIWA-Ar). The rate of withdrawal and total duration of withdrawal were compared among the two groups.
Results: The severity of alcohol dependence, assessed using the SADQ (LOR=23.33 ± 10.57, CDZ=23.43 ± 7.64) indicated moderate alcohol dependence for both the groups. Lorazepam and Chlordiazepoxide showed similar efficacy in reducing symptoms of alcohol withdrawal as assessed using the revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar) across 8 treatment days. No difficulties in drug discontinuation were observed with either drug.
Conclusion: With the treatment schedule used in this study, Lorazepam is as effective as the more traditional drug Chlordiazepoxide in the treatment of uncomplicated alcohol withdrawal. Higher doses of Lorazepam than those formerly used may be necessary during alcohol withdrawal