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Managing alcohol withdrawal.

Sedative-hypnotic agents are more effective than neuroleptic agents in reducing mortality in alcohol withdrawal delirium popularly known as delirium tremens.

In a metaanalysis of nine prospective controlled trials, Dr. Michael F. Mayo-Smith and his associates found a summary relative risk of mortality with neuroleptics of 6.6, compared with sedative hypnotics. Sedative hypnotics were also superior to neuroleptics in reducing the duration of delirium in three of four trials that compared the two agents (Arch. Intern. Med. 164[13]:1405-412, 2004).

Intravenous diazepam achieved quicker sedation of patients, compared with rectal paraldehyde in one study, and there was no difference in sedation times between intramuscular diazepam and oral barbital in another, said Dr. Mayo-Smith of the Veterans Affairs Medical Center, Manchester, N.H.

In addition to using parenteral rapid-acting sedative-hypnotic agents that are cross-tolerant with alcohol, the investigators recommended comprehensive supportive care, including history, physical exam, and a thorough diagnostic evaluation.
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Title Annotation:Clinical Capsules
Author:Foley, Kevin
Publication:Clinical Psychiatry News
Article Type:Brief Article
Geographic Code:1USA
Date:Sep 1, 2004
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