Magazine article Clinical Psychiatry News

Benzodiazepines Discouraged for Alcohol Withdrawal

Magazine article Clinical Psychiatry News

Benzodiazepines Discouraged for Alcohol Withdrawal

Article excerpt

EXPERT ANALYSIS FROM THE NPA ANNUAL PSYCHOPHARMOCOLOGY UPDATE

LAS VEGAS--Alpha-2 agonists and a handful of other agents work at least as well as benzodiazepines for alcohol withdrawal, and they're safer, according to Dr. Jose R. Maldonado. That's why he advises against using benzodiazepines to treat alcohol withdrawal.

The risks of benzodiazepines include delirium, confusion, and respiratory depression. Also, patients are more likely to return to drinking if they undergo detox with benzodiazepines rather than a medication from another drug class, said Dr. Maldonado of the department of psychiatry and behavioral sciences at Stanford (Calif) University.

And perhaps most significantly, chronic alcohol abuse downregulates the receptors targeted by benzodiazepines, which means that people can still go into withdrawal despite the use of these drugs.

Meanwhile, numerous studies show that other agents, including valproic acid, gabapentin, carbamazepine, and alpha-2 blockers like donidine, are just as effective. 'Any of those alone will work," he said. Because of these data, Dr. Maldonado no longer prescribes benzodiazepines, he said at the annual psychopharmacology update held by the Nevada Psychiatric Association.

Instead, Dr. Maldonado and his colleagues use a nonbenzodiazepine withdrawal protocol based on the alpha-2 agonist clonidine because alpha-2 blockers address the norepinephrine overload that drives 85% of the withdrawal symptoms. The drugs "slow the release of excess norepinephrine," he said. …

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