Selection among benzodiazepines for alcohol withdrawal

Abstract

Four pharmacologic differences among the benzodiazepines, which are the drugs of choice to conduct alcohol withdrawal, guide selection of the appropriate one: chlordiazepoxide, diazepam, oxazepam, or chlorazepate. Bases for selection include: (1) availability of other than oral dosage forms; (2) differences in additive effect with alcohol in producing central nervous system depression; (3) differences in anticonvulsant effect; and (4) differences in duration of effect in the body (ie, half-life). Decreasing dosage schedules are preferred to a steady dosage. Illustrative dosage schedules for using chlordiazepoxide and diazepam to conduct alcohol withdrawal are given.