Chlormethiazole or chloridazepoxide in alcohol detoxification

Abstract

To date chlordiazepoxide and chlormethiazole have both been used widely to treat alcohol withdrawal symptoms. They appear to be equally effective but there are few comparative data available and some of what is available is flawed. Chlordiazepoxide does seem to be the safer alternative since chlormethiazole has a much narrower safety margin and is considered dangerous in patients who are still misusing alcohol. Because of this, the CRAG/SCOTMEG Working Group on Mental Illness in their good practice statement (1994) do not support the use of chlormethiazole. As mentioned previously, chlormethiazole has highly variable bioavailability which makes the effect of a given dose difficult to predict in an individual, and it is not licensed for use in out-patients unless the daily dose is being monitored closely. Because of the restrictions on chlormethiazole's use and the problems associated with it, chlordiazepoxide should therefore be the preferred drug in alcohol detoxification.