Patients with Alcohol Problems

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Abstract
In their excellent review of alcohol problems, O'Connor and Schottenfeld (Feb. 26 issue)1 discuss several ways to treat the alcohol withdrawal syndrome. Although infrequently used therapies such as carbamazepine are considered, the authors do not mention chlormethiazole (clomethiazole), a derivative of vitamin B1 with sedative and anticonvulsant properties, which is widely used in Europe but not approved for use in the United States.2 Like benzodiazepines, chlormethiazole can cause respiratory depression, which is the main factor limiting its use. It controls agitation and seizures effectively. The availability of solutions containing 4 g of chlormethiazole in 500 ml of water allows for continuous intravenous administration with adjustment of the dose according to the clinical symptoms, resulting in stable plasma levels.