What is the role of longer-acting benzodiazepines in the treatment of delirium tremens (DTs)?

Updated: Nov 06, 2020
  • Author: Michael James Burns, MD, FACEP, FACP, FIDSA; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
  • Print
Answer

The longer-acting benzodiazepines, such as chlordiazepoxide and diazepam, appear to be more effective at preventing the serious complications of seizures and DTs than are shorter-acting benzodiazepines such as alprazolam and oxazepam. Most experts recommend that intermittent IV bolus dosing of diazepam or lorazepam is the treatment of choice for drug therapy of DTs. In patients refractory to benzodiazepine therapy alone, barbiturates or propofol, and occasionally other drugs, may be added. [20]   A review of 4 randomized controlled trials of front-loaded diazepam concluded that it produces a rapid calming effect with few untoward adverse effects in medically ill patients, required much less total dose of benzodiazepines, and resulted in a shorter duration of treatment, but may result in over sedation and respiratory depression in very elderly persons or those with severe liver disease. [21]


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!