Comparative Evaluation of Treatments of Alcohol Withdrawal Syndromes

Abstract

In a clinical comparative study, 49 patients were treated for the tremulous and agitated states and acute hallucinosis of alcohol withdrawal. Thirteen patients were treated with promazine hydrochloride, and 12 each with paraldehyde and chloral hydrate, alcohol, or chlordiazepoxide hydrochloride. Of these therapies, paraldehyde with chloral hydrate was most effective and best tolerated. Twenty-three patients were treated for delirium tremens. Twelve were treated with promazine and suffered numerous complications, including death in two cases. Eleven were treated with paraldehyde and chloral hydrate with prompt clearing of hallucinations; there were no failures and only one complication (transient fever).From the Wood (Wis) Veterans Administration

Benzodiazepines in the Treatment of Epilepsy A Review

“…Paraldehyde was not tested. In a smaller, randomly controlled study, Golbert et al (1967) found chlordiazepoxide to be better than promazine in preventing fever, pneumonia, delirium tremens, and death during alcohol withdrawal. The combination of paraldehyde and chloral hydrate was also found to be equal to, or better than, chlordiazepoxide in the prevention of each of these consequences.…”

“…Controlled trials (Golbert et al 1967;Kaim et al 1969) of drugs administered early in the course of alcohol withdrawal to prevent the development ofmore severe symptoms have indicated that chlordiazepoxide is superior to phenothiazines, hydroxyzine, thiamine, and placebo in controlling alcohol withdrawal seizures. Only the combination of paraldehyde and chloral hydrate has been reported to be as effective as chlordiazepoxide in preventing alcohol withdrawal seizures (Golbert et al 1967).…”

“…Only the combination of paraldehyde and chloral hydrate has been reported to be as effective as chlordiazepoxide in preventing alcohol withdrawal seizures (Golbert et al 1967). …”

Implementing managed alcohol programs in hospital settings: A review of academic and grey literature

“…Six controlled trials with [44][45][46][47][48] and without [49] randomisation compared the use of alcohol to other treatments or placebos for treating [45,49] or preventing AWS [44,[46][47][48]. Alcohol was administered intravenously [46][47][48], orally [49], both orally and intravenously concurrently [45], and orally or via nasogastric tube [44]. Five studies found alcohol to be either effective for treating or preventing AWS [44,47,49], or non-inferior to the alternative treatments [46,48].…”

Chlormethiazole in the management of alcohol withdrawal

“…The results of a series of comparative studies carried out in the 1960s and recently reviewed by Gessner (8), made it clear that the major tranquillizers were markedly inferior to sedative-type drugs in this condition. Several studies in the 1960s (9)(10)(11)(12) showed that the incidence of seizures and of delirium tremens was much higher in patients treated with major tranquillizers, and mortality rates were also significantly higher.…”