Double-blind comparison of lorazepam and diazepam in the treatment of the acute alcohol abstinence syndrome

The anxiolytic efficacy and safety of lorazepam and diazepam were evaluated and compared during a 5-day double-blind trial in 52 patients who were experiencing symptoms of acute alcohol withdrawal. The total daily doses of lorazepam and diazepam were tapered from 6 to 2 mg and from 30 to 10 mg, respectively, during the first 4 days; no medication was given on day 5. Drug effectiveness was measured by improvements in the Total Severity Assessment Scores (TSAS), in the scores for the three composite TSAS factors, and by the physician's global rating. One patient treated with lorazepam had a drug-related adverse experience (confusion) that resulted in discontinuation of therapy, and one diazepam-treated patient discontinued because of a drug-related rash. Aside from a significant drop in blood pressure in diazepam-treated patients, vital signs were not appreciably different between treatment groups. Laboratory values remained within the normal limits in both groups. The results of this study indicate that lorazepam was as effective as diazepam in reducing the symptoms of acute alcohol withdrawal. Because of its insignificant accumulation in plasma during multiple-dose therapy, its simpler and more predictable metabolic pathway, and less tendency for abuse, lorazepam may be the drug of choice if benzodiazepine therapy is required for chronic alcoholics with acute withdrawal symptoms.