A Prospective Evaluation of Benzodiazepine Guidelines in the Management of Patients Hospitalized for Alcohol Withdrawal

Our institution adopted guidelines for the selection of benzodiazepines to be administered to patients hospitalized for alcohol withdrawal. We assessed the guidelines' impact on prescribing habits, benzodiazepine dosage requirements and costs, and length of intensive care unit (ICU) stay. A 6‐month prospective, observational study was performed in 50 patients who exhibited signs of alcohol withdrawal and received benzodiazepine therapy. Appropriate therapy was defined as lorazepam for patients 60 years and older or those with hepatic dysfunction, and chlordiazepoxide for all other patients. Benzodiazepine costs were calculated based on acquisition cost. Based on our guidelines, 76% of patients were appropriate candidates for a long‐acting agent such as chlordiazepoxide; 61% of these candidates actually received such a drug. Using a benzodiazepine conversion to compare doses in chlordiazepoxide equivalents, there was a significant difference in the total mean dose of chlordiazepoxide (1295.5 mg, SD ± 1571) compared with lorazepam (365.5 mg; SD ± 446) (p<0.01). The mean total chlordiazepoxide acquisition cost was $61.74 (range $0.03–585.98) per patient (28 patients); prior to adoption of the guidelines, the mean cost of benzodiazepine therapy was $1008.72 (± $1554.45). For patients receiving chlordiazepoxide, the mean days of ICU and hospital stay were 1.1 days (range 0–9 days) and 5.6 days (range 1–17 days), respectively; before adoption of the guidelines, the mean number of days of ICU stay was significantly greater (4.1 days, p<0.0001). The guidelines resulted in a substantial change in benzodiazepine prescribing patterns. For the management of patients hospitalized for alcohol withdrawal, chlordiazepoxide can be given safely in higher dosages than previously described, is associated with minimal acquisition costs, and in select patients may facilitate non‐ICU management compared with alternative therapies, and thus result in significant cost savings for the provider institution and third‐party payers.