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Meta-Analysis
. 2010 Mar 17;2010(3):CD005064.
doi: 10.1002/14651858.CD005064.pub3.

Anticonvulsants for alcohol withdrawal

Silvia Minozzi  1 , Laura Amato, Simona Vecchi, Marina Davoli
Affiliations
Meta-Analysis

Anticonvulsants for alcohol withdrawal

Silvia Minozzi et al. Cochrane Database Syst Rev. .

Abstract

Background: Alcohol abuse and dependence represents a most serious health problem worldwide with major social, interpersonal and legal interpolations. Besides benzodiazepines, anticonvulsants are often used for the treatment of alcohol withdrawal symptoms. Anticonvulsants drugs are indicated for the treatment of alcohol withdrawal syndrome, alone or in combination with benzodiazepine treatments. In spite of the wide use, the exact role of the anticonvulsants for the treatment of alcohol withdrawal has not yet bee adequately assessed.

Objectives: To evaluate the effectiveness and safety of anticonvulsants in the treatment of alcohol withdrawal.

Search strategy: We searched Cochrane Drugs and Alcohol Group' Register of Trials (December 2009), PubMed, EMBASE, CINAHL (1966 to December 2009), EconLIT (1969 to December 2009). Parallel searches on web sites of health technology assessment and related agencies, and their databases.

Selection criteria: Randomized controlled trials (RCTs) examining the effectiveness, safety and overall risk-benefit of anticonvulsants in comparison with a placebo or other pharmacological treatment. All patients were included regardless of age, gender, nationality, and outpatient or inpatient therapy.

Data collection and analysis: Two authors independently screened and extracted data from studies.

Main results: Fifty-six studies, with a total of 4076 participants, met the inclusion criteria. Comparing anticonvulsants with placebo, no statistically significant differences for the six outcomes considered.Comparing anticonvulsant versus other drug, 19 outcomes considered, results favour anticonvulsants only in the comparison carbamazepine versus benzodiazepine (oxazepam and lorazepam) for alcohol withdrawal symptoms (CIWA-Ar score): 3 studies, 262 participants, MD -1.04 (-1.89 to -0.20), none of the other comparisons reached statistical significance.Comparing different anticonvulsants no statistically significant differences in the two outcomes considered.Comparing anticonvulsants plus other drugs versus other drugs (3 outcomes considered), results from one study, 72 participants, favour paraldehyde plus chloral hydrate versus chlordiazepoxide, for the severe-life threatening side effects, RR 0.12 (0.03 to 0.44).

Authors' conclusions: Results of this review do not provide sufficient evidence in favour of anticonvulsants for the treatment of AWS. There are some suggestions that carbamazepine may actually be more effective in treating some aspects of alcohol withdrawal when compared to benzodiazepines, the current first-line regimen for alcohol withdrawal syndrome. Anticonvulsants seem to have limited side effects, although adverse effects are not rigorously reported in the analysed trials.

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Conflict of interest statement

None.

Figures

1
1
Flow chart showing identification of studies
2
2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
3
3
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
4
4
Forest plot of comparison: 1 Anticonvulsant versus Placebo, outcome: 1.1 Alcohol Withdrawal Seizures post treatment.
5
5
Forest plot of comparison: 1 Anticonvulsant versus Placebo, outcome: 1.4 Adverse events (N. of patients with at least one adverse event).
6
6
Forest plot of comparison: 1 Anticonvulsant versus Placebo, outcome: 1.5 Dropout.
7
7
Forest plot of comparison: 1 Anticonvulsant versus Placebo, outcome: 1.6 Dropout due to adverse events
8
8
Forest plot of comparison: 2 Anticonvulsant versus Other, outcome: 2.1 Alcohol Withdrawal Seizures
9
9
Forest plot of comparison: 2 Anticonvulsant versus Other, outcome: 2.2 Alcohol Withdrawal Delirium
10
10
Forest plot of comparison: 2 Anticonvulsant versus Other, outcome: 2.14 Adverse events (number of patient with at least one adverse event)
11
11
Forest plot of comparison: 2 Anticonvulsant versus Other, outcome: 2.15 Severe, life‐treating adverse events
12
12
Forest plot of comparison: 2 Anticonvulsant versus Other, outcome: 2.18 Dropout.
13
13
Forest plot of comparison: 2 Anticonvulsant versus Other, outcome: 2.19 Dropout due to adverse events.
14
14
Forest plot of comparison: 3 Anticonvulsant 1 versus Anticonvulsant 2, outcome: 3.1 Adverse events (number of patients with at least one adverse event).
15
15
Forest plot of comparison: 3 Anticonvulsant 1 versus Anticonvulsant 2, outcome: 3.2 Dropout.
16
16
Forest plot of comparison: 4 (Anticonvulsant + Other) versus Other, outcome: 4.1 Alcohol Withdrawal Delirium post treatment.
17
17
Forest plot of comparison: 4 (Anticonvulsant + Other) versus Other, outcome: 4.3 Dropout.
1.1
1.1. Analysis
Comparison 1 Anticonvulsant versus Placebo, Outcome 1 Alcohol Withdrawal Seizures post treatment.
1.2
1.2. Analysis
Comparison 1 Anticonvulsant versus Placebo, Outcome 2 Adverse events.
1.3
1.3. Analysis
Comparison 1 Anticonvulsant versus Placebo, Outcome 3 Dropout.
1.4
1.4. Analysis
Comparison 1 Anticonvulsant versus Placebo, Outcome 4 Dropout due to adverse events.
2.1
2.1. Analysis
Comparison 2 Anticonvulsant versus Other Drugs, Outcome 1 Alcohol withdrawal seizures.
2.2
2.2. Analysis
Comparison 2 Anticonvulsant versus Other Drugs, Outcome 2 Alcohol withdrawal delirium.
2.3
2.3. Analysis
Comparison 2 Anticonvulsant versus Other Drugs, Outcome 3 CIWA‐Ar score (48 hrs).
2.4
2.4. Analysis
Comparison 2 Anticonvulsant versus Other Drugs, Outcome 4 CIWA‐Ar score (end of treatment).
2.5
2.5. Analysis
Comparison 2 Anticonvulsant versus Other Drugs, Outcome 5 Global Doctor's Assessment of Efficacy.
2.6
2.6. Analysis
Comparison 2 Anticonvulsant versus Other Drugs, Outcome 6 Adverse events.
2.7
2.7. Analysis
Comparison 2 Anticonvulsant versus Other Drugs, Outcome 7 Severe, life‐treatening adverse events.
2.8
2.8. Analysis
Comparison 2 Anticonvulsant versus Other Drugs, Outcome 8 Dropout.
2.9
2.9. Analysis
Comparison 2 Anticonvulsant versus Other Drugs, Outcome 9 Dropout due to adverse events.
3.1
3.1. Analysis
Comparison 3 Anticonvulsant 1 versus Anticonvulsant 2, Outcome 1 Adverse events.
3.2
3.2. Analysis
Comparison 3 Anticonvulsant 1 versus Anticonvulsant 2, Outcome 2 Dropout.
4.1
4.1. Analysis
Comparison 4 (Anticonvulsant + Other) versus Other, Outcome 1 Alcohol withdrawal delirium.
4.2
4.2. Analysis
Comparison 4 (Anticonvulsant + Other) versus Other, Outcome 2 Severe, life‐threatening adverse events.
4.3
4.3. Analysis
Comparison 4 (Anticonvulsant + Other) versus Other, Outcome 3 Dropout.
5.1
5.1. Analysis
Comparison 5 Anticonvulsant1 + other vs anticonvulsant 2, Outcome 1 alcohol withdrawal seizures.
5.2
5.2. Analysis
Comparison 5 Anticonvulsant1 + other vs anticonvulsant 2, Outcome 2 alcohol withdrawal delirium.
5.3
5.3. Analysis
Comparison 5 Anticonvulsant1 + other vs anticonvulsant 2, Outcome 3 adverse events.
5.4
5.4. Analysis
Comparison 5 Anticonvulsant1 + other vs anticonvulsant 2, Outcome 4 severe, life threatening adverse events.
5.5
5.5. Analysis
Comparison 5 Anticonvulsant1 + other vs anticonvulsant 2, Outcome 5 drop out.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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References to studies excluded from this review

Addolorato 2002 {published data only}
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Karam‐Hage 2003 {published data only}
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Keaney 2001 {published data only}
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Kiefer 2003 {published data only}
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Kramp 1979 {published data only}
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Kranzler 1996 {published data only}
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Kraus 1985 {published data only}
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Lange‐Ass 2003 {published data only}
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Leivonen 1966 {published data only}
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Loo 1986 {published data only}
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Malcolm 1992 {published data only}
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Martinotti 2007 {published data only}
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Mendels 1985 {published data only}
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Miller 1988 {published data only}
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Montejo 2007 {published data only}
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Mueller 1997 {published data only}
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Mukherjee 1983 {published data only}
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Muller 1969 {published data only}
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References to studies awaiting assessment

Gottesleben 1994 {published data only}
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