Table 2.

Comparision of Studied Adjunctive Agents in Severe Alcohol Withdrawal.

Study Medications	Dosing Ranges Used	Average Duration of Use	Outcomes	Side Effects Observed
Clonidine23	0.15-0.9; 3-4 times per day	~3 days	BZD dose reduction and shorter duration of mechanical ventilation in combination with flunitrazepam when compared to chlormethiazole/haloperidol and flunitrazepam/haloperidol	Hypotension, bradycardia, AV node block
Dexmedetomidine18,25-28,33	0.4-1.2 µg/kg/h	24 hours	Decrease in BZD requirement 24 hours and cumulative BZD consumption post-DEX administration compared to placebo. Also, with DEX, required less haloperidol requirements and had shorter length of hospital stay. When compared with propofol, DEX had a significantly less BZD requirements. No observed respiratory depression or worsening of delirium.	Bradycardia, hypotension
Propofol31,33	Mean 4.22 mg/kg/h	48 hours	Reduced symptoms in patients with AWS refractory to BZDs	Hypotension, respiratory acidosis, hypertriglyceridemia
Ketamine34	4.5-14.2 mg infusion	24 hours	Lowered BZD requirement but not statistically significant compared to placebo	Oversedation
Phenobarbital36	10 mg/kg single dose; serum concentrations 15-38 µg/mL	~9 days	Single dose of phenobarbital in the ED had a decreased ICU admission rate and decreased BZD requirement	Bradycardia, hypotension
Valproate37	300-500 mg q6-8h	122 hours	Decreased BZD requirement compared to placebo	Thrombocytopenia, hepatotoxicity
Carbamazepine39	200 mg q8h or 400 mg q12h	91 hours	Duration of treatment longer and hospital stay longer in carbamazepine when compared to valproate	Hypersensitivity reaction, nausea, vomiting

Abbreviations: BZD, benzodiazepine; DEX, dexmedetomidine; AWS, alcohol withdrawal syndrome; ED, emergency department; ICU, intensive care unit.