A review of recent studies has found that tranquilizers work better than placebo at treating the symptoms of alcohol withdrawal syndrome but they may not work better than other drugs.

The class of drugs known as benzodiazepines are especially effective at treating seizure in withdrawal patients, say Christos Ntais of the University of Ioannina School of Medicine in Greece and colleagues. People given benzodiazepines were 84 percent less likely to have withdrawal-related seizures compared to those given placebo.

“This might suggest that benzodiazepines as first-line treatment for alcohol withdrawal syndrome is justified,” Ntais and colleagues say.

However, the researchers found no evidence that benzodiazepines are any better than other drugs used for treating alcohol withdrawal syndrome or that there are any differences between types of benzodiazepines for withdrawal treatment.

“ There was no conclusive evidence or even hints for superiority of specific drugs, but modest differences could have been missed due to limited data,” Ntais says.

. In a second review, Anastasia Polycarpou, also of the University of Ioannina School of Medicine, and colleagues found some evidence that anticonvulsant drugs such as Carbamazepine ( Tegretol ) are more effective than placebo at treating alcohol withdrawal, but the difference was not statistically significant.

The reviews appear in The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research.

Alcoholics can go through withdrawal when they stop or cut back on their drinking. Symptoms of withdrawal can include everything from insomnia, sweating and rapid heart beat to nausea, seizures and hallucinations. The most severe form of withdrawal syndrome is called delirium tremens.

Alcohol addiction affects certain neurotransmitter circuits in the brain, and the symptoms of alcohol withdrawal reflect the brain’s attempt to readjust those circuits. Benzodiazepines act on one particular type of circuit called GABA pathways.

Ntais and colleagues examined 57 studies of benzodiazepine treatment for 4,051 people.
Polycarpou and colleagues analyzed 48 studies of anticonvulsant treatment for 3,610 people. Although the number of studies is relatively high for systematic reviews, the studies had a large variety of outcomes and measurements that made it difficult to combine and analyze the data as a whole.

Although not all of the studies reported side effects from the drugs, deaths and serious complications from the treatments appear to be rare.

“ The extremely small mortality rate in all these studies is reassuring, but data on other harms-related outcomes are sparse and fragmented,” Ntais says.

Sarah Book, at the Medical University of South Carolina who has studied the effects of both benzodiazepines and anticonvulsants for alcohol withdrawal, says there may be other reasons to be cautious about benzodiazepine treatment.

“ In general, benzodiazepines have the potential to increase the risk of alcoholic relapse,” Book says.
.
Book also says “the combination of alcohol and benzodiazepines can be deadly,” a problem that does not occur with anticonvulsants, she adds.

According to Book, the majority of benzodiazepine prescriptions for withdrawal are made on an outpatient basis, with little opportunity to monitor a patient’s continued drinking.

Source: Center for the Advancement of Health, 2005

XagenaMedicine2005