Benzodiazepines may protect against seizures in alcohol withdrawal syndrome

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Every once in a while the Cochrane library publish an overview of reviews to summarise the evidence for a specific intervention. Such an overview has recently been made available to bring together all of the Cochrane reviews that assess the effectiveness and safety of pharmacological interventions in the treatment of alcohol withdrawal.

The overview brings together results from 5 Cochrane reviews, containing 114 studies and 7,333 participants in total. The treatments included in the overview are:

  1. Benzodiazepines
  2. Psychotropic analgesic nitrous oxide
  3. Gamma-hydroxybutyric acid (GHB)
  4. Baclofen
  5. Anticonvulsants

The outcomes measured were alcohol withdrawal seizures, adverse events and dropouts.

Results showed:

  • When compared with placebo, benzodiazepines performed better for seizures than the other treatments: RR 0.16 (95% CI 0.04 to 0.69)
  • Comparing the 5 treatments versus specific classes of drugs, benzodiazepines performed better than antipsychotics for seizures: RR 0.24 (95% CI 0.07 to 0.88)
  • The reviewers also looked at 28 comparisons of different benzodiazepines and anticonvulsants and found that chlordiazepoxide was most effective, although results were not statistically significant

The authors concluded:

Among the treatments considered, benzodiazepines showed a protective benefit against seizures, when compared to placebo and a potentially protective benefit for many outcomes when compared with antipsychotics. Nevertheless, no definite conclusions about the effectiveness and safety of benzodiazepines were possible, because of the heterogeneity of the trials both in interventions and in the assessment of outcomes. Data on potential harms are sparse and fragmented.

Results do not provide sufficient evidence in favour of anticonvulsants for the treatment of alcohol withdrawal syndrome, but anticonvulsants seem to have limited side effects.

There is also not enough evidence of effectiveness and safety of baclofen, because only one study consider this treatment and of GHB for which no strong differences were observed in the comparisons with placebo, benzodiazepines and anticonvulsants.

Amato L, Minozzi S, Davoli M. Efficacy and safety of pharmacological interventions for the treatment of the Alcohol Withdrawal Syndrome. Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD008537. DOI: 10.1002/14651858.CD008537.pub2.

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