Clonidine as early adjunctive therapy for alcohol withdrawal in the emergency department

Lindsey Shannon, Christopher Leong, Ahmed Assem Mahmoud


Alpha-2-agonists may decrease cumulative benzodiazepines (BZD) requirements in alcohol withdrawal syndrome (AWS), leading to a reduction in BZD related adverse events. This study aimed to evaluate the impact of adjunctive clonidine on BZD requirements in patients with AWS who presented to the emergency department (ED). A retrospective chart review study from 1/2015 to 12/2016 was performed in patients who were admitted for AWS via the ED and would have received at least 24 hours of benzodiazepines. The primary study outcome was the difference of the 12-hour cumulative BZD requirements in lorazepam equivalents (BZD-LE) in patients who received clonidine compared to patients who received BZD monotherapy. Secondary endpoints included total hospital benzodiazepine requirements, intensive care unit (ICU) admission, ICU and hospital length of stay, and incidence of hypotension. A total of 11 patients who received clonidine adjunctive therapy and 33 patients to standard management were included in the study. The median 12 hour cumulative BZD-LE was 16 mg (IQR 3-19) in the intervention group compared to 7 mg (IQR 4-13) in the control group (P = 0.90). However, the total cumulative BZD-LE requirements for the hospital stay was 31 mg (IQR 21-48) in the intervention group compared to 45 mg (IQR 26-71) in the control group (P = 0.28). In conclusion, adjunctive clonidine administration to BZD in AWS initiated in the ED was not associated with a decrease in 12 hour BZD requirements.



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