NOT LOOKING FOR MEDICAL ADVICE
After the pit thread about AA(http://boards.straightdope.com/sdmb/showthread.php?t=349349) some Dopers mentioned being put on Valium when detoxed.
Here, in Ireland (where we have a fair amount of alcoholics in hospital) we use Librium (chlordiazepoxide) and only Librium to prevent DTs in alcoholics in withdrawal.
Anyone know why the difference in practice?
QtM,? KarlGauss?
At the VA hospital I worked at, the protocol called for Ativan and admission either to the ICU or a particular medical floor that was equipped for DTs and other possible problems, depending on the patient’s severity.
Robin
I was detoxed a few times at different places before I got better and they always used Ativan or Librium. I think people just say “Valium” because it is a more famous drug and is in roughly equivalent. I am sure that some places use or used Valium and it can prevent death and discomfort from alcohol withdrawal too.
We use diazepam (Valium) near exclusively and, just a WAG, but I suspect it’s a matter of tradition more than anything else. Certainly, I’m not aware of any literature to suggest superiority of one drug over the other (except, possibly, when seizures have occurred in which case lorazepam (Ativan) may be best).
The key thing is that the drug used have a long half-life, thereby conferring protection for the duration of the alcohol withdrawal. Both Librium and Valium have long half-lives (and have active metabolites also having long half-lives).
The psych hospital where Mr. SCL worked used Librium. (So he told me during our discussion of the referenced thread.)
I think clorolhydrate (spelling? It was a long damn time ago…) was used when I detoxed, as well as Valium.
In the acute upward titration phase of treating withdrawal, this may be a disadvantage. With a half life of 30-60hrs for diazepam (and up to 100hrs for metabolite desmethyldiazepam), there is a possibility that you can overmedicate to the point of respiratory depression. For this reason, in my part of the country most of us haved switched to Ativan (with a half life of about 12 hrs); can titrate up rapidly to reach point of desired suppression of withdrawal without worrying about excessive build-up of active drug/metabolite that will hang around for a long time.
In the final analysis though, any benzo (and for that matter there are detox protocols with phenobarb) will treat acute alcohol withdrawal, so it really is a matter of local custom more than anything else.
In my area (Midwest USA) the standard therapy is either ativan or librium.
Thanks, I wondered if it was just habit or if there was any data to support one over the other…seems like it’s just habit.
We use lorazepam for seizures in alcoholics but not standard detoxing.
When incarcerated many many years ago while an active alcoholic, I received valium on a pretty regular basis throughout the day. T’was the only positive thing about the situation. Oh, and of course you’d want to know - multiple DUI’s.