sweetybokhari
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in the emergency room you asked to assess a man with alcoholic cirrhosis and recent alcohol cessation.He is agitated,confused and hallucinating.you make a presumptive diagnosis of delirium tremens.what is the best treatment for his condition?
1) diazepam(valium)
2) nitrazepam(nitrazedon)
3) chlordiazepoxide(librium)
4) lorazepam(ativan)
5) clonazepam(rivotril)
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| Geroo
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3) chlordiazepoxide(librium)
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| robin082006
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3
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| sweetybokhari
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why not lorazpam? can anyone give explanation.
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| dr in trouble
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The most commonly used drug for Alcohol widhdrawl is Choldiazepoxide and diazepam due to longer half lifes as compared to lorazepam (intermediate acting.)
Physicians traditionally have used benzodiazepines by administering decreasing doses over the period of alcohol withdrawal. Rosenbloom (1988) recommends this approach, suggesting the use of intermediate half-life benzodiazepines (such as lorazepam), or even shorter half-life drugs (such as midazolam), because these drugs do not linger in the system and allow for doses to be easily titrated to the parent's response.
However, Sellers et al. (1983) introduced a different approach. At the start of treatment, doses of diazepam are given every 1 to 2 hours until withdrawal symptoms abate. Because diazepam has a long half-life and produces a psychoactive metabolite (desmethyldiazepam) with an even longer half-life, there is usually no need for further medication.
Same is for chlordiazepoxide---both diazepam and chlordiazepoxide are long acting.diazepam shud b given I/V but chordiazepoxide can b given orally.
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| sweetybokhari
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dr in trouble,i agree with all of your explanation,but in cirrhosis patient are they safe?? because diazepam and chlordiazepoxide produce active metabolites. thanks
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| dr in trouble
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yes you can use benzodiazepines in hepatic dysfunction with caution
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| r_albayunen
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then whats the answer diazepam or chlordiazepoxide?
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| life_in_mono
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I don't think its Chlordiazepoxide . This is what i found :
Chlordiazepoxide should be administered cautiously to patients with severe hepatic disese because the elimination half-life of the drug can be prolonged, possibly resulting in toxicity. The liver is utilized for metabolism of chlordiazepoxide. Patients with hepatic disease should receive reduced initial dosages and be closely monitored for tolerability. Additionally, chlordiazepoxide metabolites may accumulate leading to severe and prolonged stupor in patients with cirrhosis or hepatitis. (Drug Monogram)
I think , answer should be Lorazepam (short acting ) .Benzodiazepines with short half-lives are especially useful for patients with serious liver impairment or evidence of preexisting encephalopathy or brain damage, but result in rapidly changing drug blood levels and must be given every 4 h to avoid abrupt fluctuations in blood levels that may increase the risk for seizures. Therefore, most clinicians use drugs with longer half-lives, such as diazepam or chlordiazepoxide, administering enough drug on day 1 to alleviate most of the symptoms of withdrawal (e.g., the tremor and elevated pulse) and then decreasing the dose by 20% on successive days over a period of 3 to 5 days. (Harrison)
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