Managing alcohol withdrawal in hospitalized patients

Hartsell, Zachary; Drost, Jennifer; Wilkens, James A.; Budavari, Adriane I.

doi:10.1097/01720610-200709000-00010

Cited by 8 publications

(5 citation statements)

References 25 publications

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“…In fact, many patients can be safely managed with supportive care only, avoiding the risks and costs of unnecessary medication. 25 Older adults have more difficulty metabolizing and excreting alcohol than younger patients, and eliminate benzodiazepines at a slower rate. These drugs mimic the effects of alcohol in the central nervous system.…”

Section: Using Benzodiazepinesmentioning

confidence: 99%

Managing alcohol withdrawal in hospitalized patients

Elliott

Geyer

Lionetti

et al. 2013

Nursing Critical Care

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Section: Using Benzodiazepinesmentioning

confidence: 99%

Managing alcohol withdrawal in hospitalized patients

Elliott

Geyer

Lionetti

et al. 2013

Nursing Critical Care

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“…Between 2006 and 2010 the annual number of alcohol-associated deaths in the United States was approximately 88,000, or 9.8% of all US deaths [2]. In the United States over 500,000 episodes of alcohol withdrawal require pharmacological treatment each year, and between 2000 and 2015 the rate of hospitalizations complicated by alcohol use continued to increase from 90.45 to 156.98 per 10,0000 population [1,3]. In the same time period, the rates of alcohol related psychoses in patients hospitalized with alcohol withdrawal and alcohol treatment length of stay increased in the United States (26% to 51% of hospitalizations and 2.3 to 3.5 days respectively) [1].…”

Section: Introductionmentioning

confidence: 99%

“…Benzodiazepines can be used either per a fixed-dosage scheduled taper or a symptom-triggered taper. When a symptom-triggered taper is used, the Clinical Institute Withdrawal Assessment for Alcohol, CIWA or CIWA-Ar (revised version), is a 10-item scale frequently used in the assessment and management of alcohol withdrawal [3,5,6]. According to the most recent ASAM 2020 guideline, benzodiazepines are still considered first line therapy for patients at risk for acute moderate or severe alcohol withdrawal in the hospitalized setting [5].…”

Section: Introductionmentioning

confidence: 99%

Medical Management of Acute Alcohol Withdrawal in Hospitalized Patients at a Community Based Network of Hospitals: A Retrospective Cohort Study

2022

MCMS

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Background: In the United States over 500,000 episodes of alcohol withdrawal require pharmacological treatment each year [1].The medications for withdrawal treatment in the U.S. are benzodiazepines and barbiturates. Studies suggest these treatments are equivocal, [2] however, studies comparing outcomes of the two medications have been limited. Objective:The primary objective of this study is to compare alcohol withdrawal treatment with benzodiazepine and phenobarbital medication classes alone or in combination in hospitalized patients in a 8 hospital community-based healthcare system.Methods: This is a retrospective review of 1,602 hospital encounters with a principal diagnosis of alcohol withdrawal from 01/01/2018 to 12/31/2019. Encounters were evaluated for type of pharmacologic treatment, 30-day readmission rate, ICU admission, and intubation rates.Results: When comparing the treatment groups, patients in the phenobarbital treatment group compared to the benzodiazepine group had a statistically significant higher admission to ICU at 42% versus 28% respectively (p=0.0160). Phenobarbital and benzodiazepines were not statistically significantly different in intubation rate (p= 0.3690) or 30-day readmission rate (p=0.8626).Rates of 30-day readmission and intensive care (ICU) admission were statistically significant between the three pharmacologic treatment groups (p<0.001) with the combination of phenobarbital and benzodiazepines demonstrating the highest rates of both. Conclusion:In other similar studies [8][9][10][11], there are varied outcomes in relation to ICU admission, intubation and 30-day readmission rates when comparing benzodiazepines and phenobarbital. This study further demonstrates variation in these outcomes. Due to these substantial differences in outcomes when comparing phenobarbital and benzodiazepines, higher level studies are needed to provide conclusive evidence that phenobarbital is equivocal or superior to use of benzodiazepines for the treatment of alcohol withdrawal.

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“…Severe withdrawal symptoms are characterized by seizures, hallucinations (auditory, visual, and tactile), agitation, tremulousness, and delirium tremens where prompt therapy is necessary to control the symptoms and prevent complications. [5] The worldwide incidence of AWS is estimated to be about two million per year, of which half a million have moderate to severe withdrawal symptoms necessitating pharmacological intervention. [6]…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis of baclofen and chlordiazepoxide in uncomplicated alcohol-withdrawal syndrome

et al. 2014

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Objectives:Benzodiazepines (BZDs) are the first-line drugs in alcohol-withdrawal syndrome (AWS). Baclofen, a gamma-aminobutyric acidB (GABAB) agonist, controls withdrawal symptoms without causing significant adverse effects. The objective of this study was to compare the cost-effectiveness of baclofen and chlordiazepoxide in the management of uncomplicated AWS.Materials and Methods:This was a randomized, open label, standard controlled, parallel group study of cost-effectiveness analysis (CEA) of baclofen and chlordiazepoxide in 60 participants with uncomplicated AWS. Clinical efficacy was measured by the Clinical Institute Withdrawal Assessment for alcohol (CIWA-Ar) scores. Lorazepam was used as supplement medication if withdrawal symptoms could not be controlled effectively by the study drugs alone. Both direct and indirect medical costs were considered and the CEA was analyzed in both patient's perspective and third-party perspective.Results:The average cost-effectiveness ratio (ACER) in patient's perspective of baclofen and chlordiazepoxide was Rs. 5,308.61 and Rs. 2,951.95 per symptom-free day, respectively. The ACER in third-party perspective of baclofen and chlordiazepoxide was Rs. 895.01 and Rs. 476.29 per symptom-free day, respectively. Participants on chlordiazepoxide had more number of symptom-free days when compared with the baclofen group on analysis by Mann-Whitney test (U = 253.50, P = 0.03).Conclusion:Both study drugs provided relief of withdrawal symptoms. Chlordiazepoxide was more cost-effective than baclofen. Baclofen was relatively less effective and more expensive than chlordiazepoxide.

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Managing alcohol withdrawal in hospitalized patients

Cited by 8 publications

References 25 publications

Managing alcohol withdrawal in hospitalized patients

Managing alcohol withdrawal in hospitalized patients

Medical Management of Acute Alcohol Withdrawal in Hospitalized Patients at a Community Based Network of Hospitals: A Retrospective Cohort Study

Cost-effectiveness analysis of baclofen and chlordiazepoxide in uncomplicated alcohol-withdrawal syndrome

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