Evaluation of the course and treatment of Alcohol Withdrawal Syndrome with the Clinical Institute Withdrawal Assessment for Alcohol – Revised: A systematic review-based meta-analysis

Review question / Objective: Lorazepam and other benzodiazepines (BZDs) are considered the first choice for treatment of Alcohol withdrawal syndrome (AWS). But they have significant addiction potential and can cause fatal respiratory depression if used in large doses. The aim of our study is to conduct a network meta-analysis to provide some data support for the clinical treatment of AWS. The patients were persons with alcohol withdrawal. The intervention being studied must be a comparison of the efficacy of the two pharmacologic treatments. The study should not be included if two pharmacologic treatments belonging to the same category were compared. All studies must include one of the following outcomes: Clinical Institute Withdrawal Assessment, revised (CIWA-Ar) score, length of hospital stay, length of intensive care unit (ICU) stay, and the incidence of delirium or seizures. Condition being studied: Side effects and safety of eleven types of agents currently used to treat alcohol withdrawal syndrome.

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Patient Outcomes Associated With Phenobarbital Use With or Without Benzodiazepines for Alcohol Withdrawal Syndrome: A Systematic Review

Hospital Pharmacy ◽

10.1177/0018578717720310 ◽

2017 ◽

Vol 52 (9) ◽

pp. 607-616 ◽

Cited By ~ 6

Author(s):

Drayton A. Hammond ◽

Jordan M. Rowe ◽

Adrian Wong ◽

Tessa L. Wiley ◽

Kristen C. Lee ◽

...

Keyword(s):

Systematic Review ◽

Patient Outcomes ◽

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Observational Studies ◽

Alcohol Withdrawal Syndrome ◽

Hospital Length Of Stay ◽

Cochrane Library ◽

Controlled Trials ◽

Icu Admission

Purpose: Benzodiazepines are the drug of choice for alcohol withdrawal syndrome (AWS); however, phenobarbital is an alternative agent used with or without concomitant benzodiazepine therapy. In this systematic review, we evaluate patient outcomes with phenobarbital for AWS. Methods: Medline, Cochrane Library, and Scopus were searched from 1950 through February 2017 for controlled trials and observational studies using [“phenobarbital” or “barbiturate”] and [“alcohol withdrawal” or “delirium tremens.”] Risk of bias was assessed using tools recommended by National Heart, Lung, and Blood Institute. Results: From 294 nonduplicative articles, 4 controlled trials and 5 observational studies (n = 720) for AWS of any severity were included. Studies were of good quality (n = 2), fair (n = 4), and poor (n = 3). In 6 studies describing phenobarbital without concomitant benzodiazepine therapy, phenobarbital decreased AWS symptoms ( P < .00001) and displayed similar rates of treatment failure versus comparator therapies (38% vs 29%). A study with 2 cohorts showed similar rates of intensive care unit (ICU) admission (phenobarbital: 16% and 9% vs benzodiazepine: 14%) and hospital length of stay (phenobarbital: 5.85 and 5.30 days vs benzodiazepine: 6.64 days). In 4 studies describing phenobarbital with concomitant benzodiazepine therapy, phenobarbital groups had similar ICU admission rates (8% vs 25%), decreased mechanical ventilation (21.9% vs 47.3%), decreased benzodiazepine requirements by 50% to 90%, and similar ICU and hospital lengths of stay and AWS symptom resolution versus comparator groups. Adverse effects with phenobarbital, including dizziness and drowsiness, rarely occurred. Conclusion: Phenobarbital, with or without concomitant benzodiazepines, may provide similar or improved outcomes when compared with alternative therapies, including benzodiazepines alone.

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Symptom Triggered Therapy versus Fixed-Dosed Scheduling for Alcohol Withdrawal: A Systematic Review

10.28971/532021sa112 ◽

2021 ◽

Author(s):

Amanda Saucedo

Keyword(s):

Systematic Review ◽

Nurse Practitioners ◽

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Alcohol Withdrawal Syndrome ◽

Treatment Modalities ◽

Advanced Practice ◽

Outpatient Basis ◽

Care Nurse ◽

Common Diagnosis

Alcohol Use Disorder (AUD) is a significant health problem that is seen widely inall hospitals and in the community. Individuals who have AUD and cease to consume alcohol develop Alcohol Withdrawal Syndrome (AWS). Alcohol Withdrawal Syndrome can either be treated on an inpatient or outpatient basis. Three different pharmacological regimens for treating AWS with medications exist. The three regimens include fixeddosing, symptom-triggered, and loading dose regimens (Sachdeva et al., 2015). As Acute Care Nurse Practitioners (APRNs), AWS will be a common diagnosis treated. Advanced Practice Registered Nurses (APRNs) must be aware of the different treatment modalities and the best evidence-based regimens for treating AWS. The purpose of this project is to conduct a systematic review to determine if the use of symptom-triggered dosing compared to fixed-schedule dosing of benzodiazepines for the treatment of AWS decreases total dosage of benzodiazepines administered during the course of treatment.

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The Efficacy of Tiapride and Carbamazepine Combination Therapy in Reducing Alcohol Withdrawal Symptoms: A Systematic Review and Meta-Analysis

Pharmacopsychiatry ◽

10.1055/a-0795-3689 ◽

2018 ◽

Vol 52 (05) ◽

pp. 209-216 ◽

Cited By ~ 1

Author(s):

Sahar Latifi ◽

Thomas Messer

Keyword(s):

Systematic Review ◽

Combination Therapy ◽

Alcohol Withdrawal ◽

Meta Analysis ◽

Alcohol Withdrawal Syndrome ◽

Statistical Homogeneity ◽

Alcohol Abstinence ◽

Alternative Treatment Option ◽

Significant Efficacy ◽

Z Value

AbstractThe combination of tiapride (TIA) and carbamazepine (CBZ) as an alternative treatment option to benzodiazepines and clomethiazole has been investigated by several investigations. We performed a systematic review and meta-analysis to further explore the efficacy of this combination in order to render more definite answers whether this combination can be recommendable in the clinical practice. We systematically searched electronic databases including PubMed (MEDLINE), EMBASE, OVID, Cochrane, Google Scholar, and Scopus for human studies. Statistical homogeneity was checked by χ2 test and I2 using Cochran heterogeneity statistic. Our analysis showed a significant efficacy of the combination of TIA and CBZ in reducing alcohol withdrawal syndrome (AWS) (p<0.0001, z-value: 4.07). The cumulative analysis illustrated that the favorable efficacy of this combination therapy has been consistent over time. Our study shows that the combination of TIA/CBZ is an effective treatment in management of AWS in patients with alcohol abstinence. However, the safety of this combination could not be proven, so we recommend its prescription after an informed consent.

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Barbiturates Versus Benzodiazepine for the Treatment of Severe Alcohol Withdrawal Syndrome: A Systematic Review and Meta-Analysis of Clinical Trials

10.21203/rs.3.rs-1121796/v1 ◽

2021 ◽

Author(s):

Blerina Asllanaj ◽

Eric Chang ◽

Maha Hassan ◽

Yi McWhorter

Keyword(s):

Clinical Trials ◽

Randomized Controlled Trials ◽

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Meta Analysis ◽

Alcohol Withdrawal Syndrome ◽

Primary Treatment ◽

Controlled Trials ◽

Efficacy And Safety ◽

Randomized Controlled

Abstract Context: The utility of phenobarbital in the treatment of severe alcohol withdrawal is contentious. Objective: The aim was to conduct a meta-analysis of existing observational and randomized controlled trials investigating the efficacy and safety of phenobarbital versus commonly used benzodiazepine in the setting of severe alcohol withdrawal. Data Sources: A search of PubMed, Medline, Embase, and the Cochrane Central Register of Controlled Trials published between 1976 and September 2021 was performed using medical subject headings: “severe alcohol withdrawal”, “delirium tremens” (DT), “phenobarbital” (PB), “barbiturate”, “critical care”, “ICU”, “Trial”, “human” and “English”. We selected English-language clinical trials (observational and randomized controlled trials (RCT)) evaluating the efficacy and safety of phenobarbital (PB) compared to benzodiazepine (BZD) for the treatment of severe alcohol withdrawal syndrome (AWS) in the acute care setting. Study Appraisal and synthesis methods: Data extraction and critical appraisal were carried out independently by two authors (EC and YM) using predefined data fields. The outcome variables analyzed included (a) history of DT; (b) initial CIWA-AR score; (c) drug dosages delivered; (d) duration of medical treatment of severe AWS; (e) other adjunct medication use; (f) intensive care unit (ICU) length of stay (LOS); (g) hospital LOS; (h) readmission rate; (i) DT or seizures; (j) other complications including endotracheal intubation and mechanical ventilation. These outcomes were unanimously decided to be important as they influence the practical management of severe AWS within hospitals and institutions. Heterogeneity amongst the outcome variables of these trials was determined by Cochran’s Q statistics and I² index. The meta-analysis was prepared in accordance with PRISMA guidelines. Results: Seven studies consisting of 1 prospective RCT and 6 retrospective trials were identified. Results from all the included studies show similar variables between BZD and PB group: mean age, percentage of patients with previous DT, and median Clinical Institute Withdrawal Assessment for Alcohol Revised (CIWA-AR) scores. There were no statistically significant differences in ICU and hospital LOS when comparing the BZD and PB groups. The prevalence of DT and adjunct medication usage was higher in the BZD group; however, statistically insignificant in the meta-analysis. The pooled prevalence of intubation was similar between the two treatment groups. Lastly, Hawa et al. reported higher alcohol-related re-admission in the BZD group. Conclusions: Based on our findings, the use of PB as the primary treatment, or when used in addition/as adjunct to BZD, offers several advantages in the treatment of severe AWS. These include trend toward improved DT and seizures in severe AWS, shortened ICU and hospital LOS, and less use of adjunct medications. Further RCTs are needed to investigate PB as the primary treatment of AWS that presents with severe features.

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