The Role of Diazepam Loading for the Treatment of Alcohol Withdrawal Syndrome in Hospitalized Patients

Abstract

Diazepam loading is an effective treatment option for hospitalized patients experiencing AWS. Diazepam loading uses the concept of symptom-triggered therapy, a mainstay of current AWS treatment, while exploiting its prolonged elimination half-life and eliminating the need for additional pharmacologic therapy. Studies reviewed found diazepam loading significantly improved a number of important outcomes in AWS, including time in DTs, compared to traditional treatment strategies.

Alcohol withdrawal syndrome: mechanisms, manifestations, and management

“…The current literature does not suggest one BZD to be more efficacious than another, although differences in pharmacokinetic properties can guide selection 71, 73, 74, 75. The following recommendations include agents 75 with rapid onset to control agitation symptomswith long action to avoid breakthrough symptomswith less dependence on hepatic metabolism to lower the risk of over sedation …”

“…Increased age and liver disease significantly impact the CYP‐dependent metabolism of medications with a 50% decline in the clearance and a four‐ to ninefold increase in terminal half‐life of diazepam with accumulation and production of side effects. Therefore, in the elderly and patients with cirrhosis or severe liver dysfunction, lorazepam or oxazepam is preferred 71, 75, 76…”

“…Studies found diazepam loading to significantly reduce the risk of complications, to reduce the total dose of benzodiazepines needed, and the duration of withdrawal symptoms. A further benefit of this approach is that intensive monitoring and medication administration are limited to the early period of withdrawal 3, 75. As the loading dose regimen may cause sedation and respiratory depression, withdrawal severity and the clinical condition need to be monitored prior to each dose to avoid benzodiazepine toxicity.…”

Identification and Management of Alcohol Withdrawal Syndrome

“…The greater evidence exists for the long-acting agents (chlordiazepoxide and diazepam) [58, 59], given their ability to produce a smoother withdrawal [60]. The clinical effect is mediated by the drug (BZD) per se , and by its active metabolites produced by phase I liver oxidation.…”

Alcohol Withdrawal Treatment in the Medically Hospitalized Patient: A Pilot Study Assessing Predictors for Medical or Psychiatric Complications

“…18 Since then, benzodiazepines have become the first-line agents for alcohol withdrawal treatment because of their efficacy in treating symptoms and preventing DT and seizures. [19][20][21][22][23][24] However, standardized guidelines for the administration of benzodiazepines remain a controversy, and significant variability of alcohol withdrawal strategies can be found not only between different institutions but also often among providers working within the same hospital system.…”