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Intervention Review

Benzodiazepines for alcohol withdrawal

  1. Christos Ntais1,*,
  2. Emilios Pakos2,
  3. Panayiotis Kyzas2,
  4. John PA Ioannidis3

Editorial Group: Cochrane Drugs and Alcohol Group

Published Online: 16 JUL 2008

Assessed as up-to-date: 18 MAY 2005

DOI: 10.1002/14651858.CD005063.pub2

Database Title

Additional Information

How to Cite

Ntais C, Pakos E, Kyzas P, Ioannidis JPA. Benzodiazepines for alcohol withdrawal. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD005063. DOI: 10.1002/14651858.CD005063.pub2.

Author Information

  1. 1

    University of Ioannina School of Medicine, Department of Hygiene and Epidemiology, Ioannina, Greece

  2. 2

    University of Ioannina, Department of Hygiene and Epidemiology, Ioannina, Greece

  3. 3

    University of Ioannina School of Medicine, Department of Hygiene and Epidemiology, Evidence-based Medicine Unit, Ioannina, Greece

*Christos Ntais, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, 14 Ch Zoidi st, Ioannina, GR45444, Greece. md02802@cc.uoi.gr.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 16 JUL 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Alcohol withdrawal syndrome is a cluster of symptoms that occurs in alcohol-dependent people after cessation or reduction in alcohol use. This systematic review focuses on the evidence of benzodiazepines' use in the treatment of alcohol withdrawal symptoms.

Objectives

To evaluate the effectiveness and safety of benzodiazepines in the treatment of alcohol withdrawal.

Search strategy

We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2004), MEDLINE (1966 to October 2004) and EU-PSI PSI-Tri database with no language and publication restrictions. We also screened references of retrieved articles.

Selection criteria

All randomised controlled trials examining the effectiveness and safety of a benzodiazepine in comparison with a placebo or other pharmacological intervention or other benzodiazepine were considered.

Data collection and analysis

Two reviewers independently assessed trial quality and extracted data.

Main results

Fifty-seven trials, with a total of 4,051 people were included. Despite the considerable number of randomized controlled trials, there was a very large variety of outcomes and of different rating scales and relatively limited quantitative synthesis of data was feasible. Benzodiazepines offered a large benefit against alcohol withdrawal seizures compared to placebo (relative risk [RR] 0.16; 95% confidence interval [CI] 0.04 to 0.69; p = 0.01). Benzodiazepines had similar success rates as other drugs (RR 1.00; 95% CI 0.83 to 1.21) or anticonvulsants in particular (RR 0.88; 95% CI 0.60 to 1.30) and offered a significant benefit for seizure control against non-anticonvulsants (RR 0.23; 95% CI 0.07 to 0.75; p = 0.02), but not against anticonvulsants (RR 1.99; 95% CI 0.46 to 8.65). Changes in Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scores at the end of treatment were similar with benzodiazepines versus other drugs, although some small studies showed isolated significant differences for other, less commonly, used scales. Data on other comparisons were very limited, thus making quantitative synthesis for various outcomes not very informative.

Authors' conclusions

Benzodiazepines are effective against alcohol withdrawal symptoms, in particular seizures, when compared to placebo. It is not possible to draw definite conclusions about the relative effectiveness and safety of benzodiazepines against other drugs in alcohol withdrawal, because of the large heterogeneity of the trials both in interventions and assessment of outcomes but the available data do not show prominent differences between benzodiazepines and other drugs in success rates.

 

Plain language summary

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  2. Abstract
  3. Plain language summary

Benzodiazepines are more effective than placebo against alcohol withdrawal seizures while they have variable profile against other commonly used treatments

This Cochrane review summarizes evidence from fifty-seven randomised controlled trials evaluating the effectiveness and safety of benzodiazepines in the treatment of alcohol withdrawal symptoms. The available data show that benzodiazepines are effective against alcohol withdrawal seizures when compared to placebo. However, there are no prominent differences between benzodiazepines and other drugs in success rates. Data on safety outcomes are sparse and fragmented. There is a need for larger, well-designed studies in this field.

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