Double‐Blind Trial of Alprazolam and Chlordiazepoxide in the Management of the Acute Ethanol Withdrawal Syndrome

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Abstract
A sequential sample of 101 patients hospitalized for ethanol withdrawal and requiring sedation for evolving withdrawal syndromes was assigned randomly according to a double-blind protocol to treatment with either alprazolam or chlordiazepoxide administered orally. The data from 1 patient were unevaluable due to acute bleeding, leaving a sample of 100 (50 in each condition). At discharge, 3 independent ratings of diaphoresis, tremor, hallucinations, nausea/vomiting and overall severity of withdrawal were obtained and the occurrence of delirium tremens and grand malseizures was noted. Patients also completed the Beck Depression Inventory and their disposition following discharge was recorded. There were no statistically significantly differences between the 2 treatment groups on any of the dependent variables studied. The choice between alprazolam and chlordiazepoxide for managing ethanol withdrawal should be based on criteria other than efficacy of control. Potential antidepressant effects and drug kinetics were suggested as the basis for rational decision-making.