Anticonvulsant drugs in alcohol withdrawal: use of phenytoin, primidone, carbamazepine, valproic acid, and the sedative anticonvulsants.

The evidence for the efficacy of anticonvulsant drugs in the control of seizures during alcohol withdrawal is examined. The literature on the use of anticonvulsants to control anxiety, irritability, tension, and other symptoms of abstinence syndrome is reviewed. The data on benzodiazepines, phenobarbital, hydroxyzine, and neuroleptics are discussed briefly. There is no evidence to support the routine use of phenytoin for seizure prophylaxis in detoxication. However, phenytoin may be valuable in patients at a high risk for seizures, such as skid-row alcoholics. Only one retrospective study has been done on primidone; it claimed primidone was an efficacious adjuvant. Carbamazepine and valproic acid may be useful in the treatment of anxiety, dysphoric mood, somatization, and other symptoms of abstinence syndrome, as well as for seizure prophylaxis. The benzodiazepines, diazepam and chlordiazepoxide, are recognized as primary therapeutic agents in the detoxication of alcoholic patients. The major difficulty with the use of phenobarbital is that it cannot be used over as wide a range as the benzodiazepines. Hydroxyzine has been shown to be inferior to chlorazepate dipotassium. Most neuroleptics appear to be inappropriate for detoxication because they lower the seizure threshold; however, haloperidol has been found efficacious in acutely abstinent alcoholics. Carbamazepine, valproic acid, primidone, and phenobarbital should be tested against standard drugs such as chlordiazepoxide and diazepam in the detoxication of alcoholic patients.