Guirguis Erenie, Richardson Jonathan, Kuhn Tara, Fahmy Ashley
Palm Beach Atlantic University, West Palm Beach, FL, USA.
J Pharm Technol. 2017 Oct;33(5):204-212. doi: 10.1177/8755122517714491. Epub 2017 Jun 19.
To review adjunctive treatment options for severe alcohol withdrawal. The search strategy included a search of Ovid MEDLINE using keywords , , , , , , , , , and and included articles dated from January 1990 to March 2017. All English-language clinical trials and case reports assessing the efficacy of adjunctive agents in severe alcohol withdrawal were evaluated. Although first-line pharmacotherapy for alcohol withdrawal continues to be benzodiazepines, literature does not clearly define adjunctive treatment options for severe alcohol withdrawal. During severe alcohol withdrawal patients may become unable to tolerate or may become unresponsive to high-dose benzodiazepines. Large doses of benzodiazepines may also result in oversedation, respiratory insufficiency, and worsening delirium. Phenobarbital and dexmedetomidine are both viable adjunctive treatment options for severe alcohol withdrawal. Current evidence has shown these agents decrease the dose requirements of benzodiazepines with limited incidence of adverse reactions. Propofol may also be a viable option in mechanically ventilated patients, but its lack of clear safety and efficacy advantages over current treatment options may limit its use in practice. Clonidine, oral anticonvulsants, and ketamine require further controlled clinical trials to clearly define their role in the treatment of severe alcohol withdrawal.
回顾严重酒精戒断的辅助治疗选择。检索策略包括使用关键词、、、、、、、、、和在Ovid MEDLINE上进行检索，检索范围包括1990年1月至2017年3月发表的文章。对所有评估辅助药物在严重酒精戒断中疗效的英文临床试验和病例报告进行了评估。虽然酒精戒断的一线药物治疗仍然是苯二氮䓬类药物，但文献并未明确界定严重酒精戒断的辅助治疗选择。在严重酒精戒断期间，患者可能无法耐受高剂量苯二氮䓬类药物或对其无反应。大剂量苯二氮䓬类药物也可能导致过度镇静、呼吸功能不全和谵妄加重。苯巴比妥和右美托咪定都是严重酒精戒断可行的辅助治疗选择。目前的证据表明，这些药物可降低苯二氮䓬类药物的剂量需求，不良反应发生率有限。丙泊酚对于机械通气患者也可能是一种可行的选择，但其相对于目前治疗选择缺乏明确的安全性和有效性优势，可能会限制其在实际中的应用。可乐定、口服抗惊厥药和氯胺酮需要进一步的对照临床试验来明确它们在严重酒精戒断治疗中的作用。
