Comparative Clinical Evaluation of Chlordiazepoxide and Promazine in Treatment of Alcohol-withdrawal Syndrome

Abstract

A double-blind comparative evaluation was made of placebo, chlordiazepoxide, and promazine for the treatment of withdrawal symptoms in 58 male alcoholics admitted to hospital within 24 hours of their last drink. Chlordiazepoxide was given in total daily doses of 200 and 400 mg., and promazine in doses of 400 and 800 mg. The five treatment groups were compared with respect to hours of sleep, blood-pressure, pulse rate, spontaneous and intention tremor (measured photoelectrically), electrical resistance of the skin, and calorie intake. Observations were made before the start of treatment and twice daily clavc nn treatment for threp Both promazine and chlordiazepoxide were more effective than the placebo in promoting sleep and diminishing sweating, but tolerance developed quickly to promazine while chlordiazepoxide remained effective. Promazine reduced tremor significantly, while chlordiazepoxide did not, or even increased it. Promazine rapidly produced a marked postural hypotension and compensatory tachycardia, while chlordiazepoxide caused a more gradual onset of hypotension. Neither drug improved the appetite compared with the placebo. Grand-mal seizures or delirium tremens occurred in five patients on promazine, one on placebo, and none on chlordiazepoxide. Chlordiazepoxide appeared to be the better drug for the treatment of alcohol-withdrawal symptoms, but the total benefit produced by it constituted a relatively small addition to the placebo effect. © 1965, British Medical Journal Publishing Group. All rights reserved.