2. Mayo-smith Mf: Pharmacological Management of Alcohol Withdrawal. a Meta-analysis and Evidence-based Practice Guideline. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal

Are benzodiazepines and anticonvulsants effective for patient with alcohol withdrawal symptoms？(Are anticonvulsants more effective than benzodiazepines？) P: alcohol withdrawal I: benzodiazepines and anticonvulsants C: placebo or active placebo O: prevent or relief alcohol symptoms (ex: delirium, seizure) , prevent re-intake alcohol 關鍵字(Key words): (alcohol withdrawal and benzodiazepine) (alcohol withdrawal and anticonvulsants) PubMed: 106 papers (alcohol withdrawal and benzodiazepine) 186 papers (alcohol withdrawal and anticonvulsants) Medline: 244 papers (alcohol withdrawal and benzodiazepine) 120 papers (alcohol withdrawal and anticonvulsants) Cochrane: 1 papers (alcohol withdrawal and benzodiazepine) 1 papers (alcohol withdrawal and anticonvulsants) 參考文獻摘要與等級(Level 1A:systemic review of RCT；Level 1B:single RCT; Level 2A:systemic review of cohort study；level 2B:cohort study or poor RCTs；Level 3:case control；Level 4:case series；Level 5:expert opinion)(level 5) Benzodiazepines, especially diazepam and chlordiazepoxide, are the drugs of choice. Barbiturates, beta-blockers, and antipsychotics are generally not recommended as first-line therapy. carbamazepine and clonidine, have been shown to be about as effective as benzodiazepines in a few studies, but the studies were small. beta-blockers, may play a role as adjuncts to, not replacements for, benzodiazepine therapy. Benzodiazepines reduce withdrawal severity, reduce incidence of delirium (P=.04), and reduce seizures (P=.003), significantly less medication and shorter treatment (P<.001). beta-Blockers, clonidine, and carbamazepine ameliorate withdrawal severity, but evidence is inadequate to determine their effect on delirium and seizures. Benzodiazepines are suitable agents for alcohol withdrawal, with choice among different agents guided by duration of action, rapidity of onset, and cost. Dosage should be individualized, based on withdrawal severity measured by withdrawal scales, comorbid illness, and history of withdrawal seizures. beta-Blockers, clonidine, carbamazepine, and neuroleptics may be used as adjunctive therapy but are not recommended as monotherapy.