Treatment of Alcohol Withdrawal Syndrome-Reply

In Reply.— I agree with Dr Wartenberg that chlordiazepoxide and diazepam should preferably be administered orally in the treatment of the acute alcohol withdrawal syndrome and that when given parenterally the drugs should be given IV rather than IM. However, the IM route often is the only one available in alcoholics because their total behavioral unmanageability precludes the use of other routes. Even though Hosein et al1have indicated that IM lorazepam is effective in the treatment of acute alcohol withdrawal and incipient delirium tremens, the manufacturers' literature states that "there is no evidence to support the use of lorazepam injection in coma, shock, or acute alcohol intoxication at this time." Incidentally, the manufacturers' literature lists IM injection as an acceptable route of administration of this drug.