Drug Utilization Evaluation of Lorazepam in Alcohol Withdrawal Syndrome Patients: A Secondary Care Teaching Hospital Based Study

Background: Drug utilization evaluation is an important parameter for the safe, effective and rational use of medications in medical care. Alcoholism results in abundant cases of alcohol withdrawal which can prove to be life-threatening if untreated, lorazepam is a drug of choice for Alcohol Withdrawal Syndrome and requires close monitoring as its over-dosing or under-dosing is common in case of withdrawal. Objective: ensures the safe and rational use of Lorazepam in the management of Alcohol Withdrawal Syndrome. Materials and Method: This prospective, observational study was conducted among alcoholic patients admitted in the KC General Hospital, Karnataka, India. Baseline data for Clinical Institute Withdrawal Assessment for Alcohol revised scale (CIWA-Ar) was collected on the day of admission and the response to lorazepam treatment was recorded using the same with respect to the baseline data every 12th hourly after the initial administration until withdrawn. Results: Statistical analysis for 72 patients was done using ANOVA to calculate the overall progression of the syndrome with treatment. Among 72 patients 94.44% were male and 5.55% were female. The mean age of patients reported with AWS was found to be 44.90 years. A significant CIWA-Ar score reduction was observed with a p-value of <0.0001. Conclusion: Our study revealed a strong predominance of male patients with alcohol withdrawal syndrome, where maximum patients started consuming alcohol before the age of 20 years. After the administration of lorazepam, a significant CIWA-Ar score reduction was observed. Keywords: Alcohol Withdrawal Syndrome, CIWA-Ar scale, Drug utilization evaluation, Lorazepam.

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Study on drug utilization pattern and cost analysis among the psychiatric patients treated with various benzodiazepine derivatives

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20202193 ◽

2020 ◽

Vol 9 (6) ◽

pp. 975

Author(s):

Dhivya Govindasamy ◽

Gandhibabu Ramanathan ◽

Talari Venkata Siva Prasad ◽

Gopalakrishnan Ganesan

Keyword(s):

Cost Analysis ◽

Drug Utilization ◽

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Psychiatric Patients ◽

Age Groups ◽

Alcohol Withdrawal Syndrome ◽

Defined Daily Dose ◽

Utilization Pattern ◽

Daily Dose

Background: The objective of the study was to assess drug utilization pattern and cost analysis among the psychiatric patients treated with various benzodiazepine derivatives.Methods: This observational study was conducted in department of psychiatric, RMMCH, Annamalai University. The study period was 6 months (November 2018 to April 2019). A total of 50 psychiatric patients were included.Results: A total 50 patients among them 64% (32) males and 36% (18) female, were included in the study. Most of the patient were between the age groups of 18-29 years (30%). The most common clinical condition treated with benzodiazepines were alcohol dependence syndrome/alcohol withdrawal syndrome/ alcohol related psychotic disorder (34%). The majority of patients were prescribed with clonazepam (66.67%). The defined daily dose (DDD) per 100 bed days of benzodiazepines were found to be 0.89. In this study the comparison of cost analysis for the drug used and it was found that lorazepam (122%) are most expensive followed by chlordiazepoxide (93.3%) and clonazepam (78.57%). The cheapest drug was nitrazepam (36.84%).Conclusions: The majority of the patient admitted in the psychiatric department were suffering from Alcohol depending syndrome/alcohol withdrawal syndrome. The most commonly prescribed benzodiazepine was clonazepam followed by lorazepam and least prescribed diazepam and nitrazepam based on defined daily dose concept.

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Treatment of the Acute Alcohol-Withdrawal Syndrome

Quarterly Journal of Studies on Alcohol ◽

10.15288/qjsa.1958.19.118 ◽

1958 ◽

Vol 19 (1) ◽

pp. 118-124 ◽

Cited By ~ 4

Author(s):

Lincoln Godfrey ◽

Martin D. Kissen ◽

Thomas M. Downs

Keyword(s):

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Alcohol Withdrawal Syndrome

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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

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2021.108536 ◽

2021 ◽

Vol 220 ◽

pp. 108536 ◽

Cited By ~ 1

Author(s):

Ildikó Katalin Pribék ◽

Ildikó Kovács ◽

Bettina Kata Kádár ◽

Csenge Sára Kovács ◽

Mara J. Richman ◽

...

Keyword(s):

Systematic Review ◽

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Meta Analysis ◽

Alcohol Withdrawal Syndrome

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Implementation of the Modified Minnesota Detoxification Scale (mMINDS) for Alcohol Withdrawal Syndrome in Critically Ill Patients

The Joint Commission Journal on Quality and Patient Safety ◽

10.1016/j.jcjq.2020.08.006 ◽

2020 ◽

Vol 46 (11) ◽

pp. 656-658

Author(s):

Rachel M. Smith ◽

Brian Benzio ◽

Andrew L. Hendrickson ◽

Evan D. Telford ◽

Andrew J. Franck

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Alcohol Withdrawal Syndrome

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Should the CIWA-Ar be the standard monitoring strategy for alcohol withdrawal syndrome in the intensive care unit?

Addiction Science & Clinical Practice ◽

10.1186/s13722-021-00226-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Tessa L. Steel ◽

Shewit P. Giovanni ◽

Sarah C. Katsandres ◽

Shawn M. Cohen ◽

Kevin B. Stephenson ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Alcohol Withdrawal Syndrome ◽

Patient Characteristics ◽

Response To Treatment ◽

Alternative Measure ◽

Icu Patients ◽

Verbal Responses

Abstract Background The Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) is commonly used in hospitals to titrate medications for alcohol withdrawal syndrome (AWS), but may be difficult to apply to intensive care unit (ICU) patients who are too sick or otherwise unable to communicate. Objectives To evaluate the frequency of CIWA-Ar monitoring among ICU patients with AWS and variation in CIWA-Ar monitoring across patient demographic and clinical characteristics. Methods The study included all adults admitted to an ICU in 2017 after treatment for AWS in the Emergency Department of an academic hospital that standardly uses the CIWA-Ar to assess AWS severity and response to treatment. Demographic and clinical data, including Richmond Agitation-Sedation Scale (RASS) assessments (an alternative measure of agitation/sedation), were obtained via chart review. Associations between patient characteristics and CIWA-Ar monitoring were tested using logistic regression. Results After treatment for AWS, only 56% (n = 54/97) of ICU patients were evaluated using the CIWA-Ar; 94% of patients had a documented RASS assessment (n = 91/97). Patients were significantly less likely to receive CIWA-Ar monitoring if they were intubated or identified as Black. Conclusions CIWA-Ar monitoring was used inconsistently in ICU patients with AWS and completed less often in those who were intubated or identified as Black. These hypothesis-generating findings raise questions about the utility of the CIWA-Ar in ICU settings. Future studies should assess alternative measures for titrating AWS medications in the ICU that do not require verbal responses from patients and further explore the association of race with AWS monitoring.

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