Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is moderate or low to moderate where GRADE has been performed and the intervention may be more effective/beneficial than the comparison for key outcomes.
Population: Patients with alcohol withdrawal (mostly male adults, age range 18-63 years old where reported)
Intervention: Benzodiazepines ᵃ
Comparison: Placebo ᵃ
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Alcohol withdrawal seizures (trial duration unclear) | Favours intervention | Moderate |
Adverse events (trial duration unclear) | No statistically significant difference | Low |
Dropout due to adverse events (trial duration unclear) | No statistically significant difference | GRADE assessment not performed for this outcome |
Alcohol withdrawal delirium, withdrawal symptoms at end of treatment, number of patients with global improvement, craving | - | None of the studies identified by the review assessed these outcomes |
Note The Cochrane review which underpins this Cochrane Clinical Answer (CCA) notes that data on the potential harms of benzodiazepines in patients with alcohol withdrawal is sparse and fragmented. ᵃ This evidence table summarises the findings for the comparison of benzodiazepines (most studies used diazepam or chlordiazepoxide; one study used lorazepam) versus placebo, which is the main comparison as stated in the Cochrane review Summary of Findings table. See the full CCA for information on other comparisons (benzodiazepine versus other drugs; benzodiazepine versus an alternative benzodiazepine).
This evidence table is related to the following section/s:
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is moderate or low to moderate where GRADE has been performed and there may be no difference in effectiveness between the intervention and comparison for key outcomes.
Population: People with alcohol withdrawal
Intervention: Benzodiazepines, anticonvulsants, or antipsychotics ᵃ
Comparison: Each other
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Benzodiazepines versus anticonvulsants | ||
Alcohol withdrawal seizures (mean follow‐up 10 days) | No statistically significant difference | Moderate |
Overall adverse events (mean follow‐up 10 days) | No statistically significant difference | Low |
Withdrawals due to adverse events | No statistically significant difference | Moderate |
Alcohol withdrawal delirium, alcohol withdrawal symptoms, serious adverse events | - | None of the studies identified by the review assessed these outcomes |
Benzodiazepines versus antipsychotics | ||
Alcohol withdrawal seizures (mean follow‐up 10 days) | Favours benzodiazepines | High |
Overall adverse events (mean follow‐up 10 days) | No statistically significant difference | Moderate |
Withdrawals due to adverse events | No statistically significant difference | High |
Alcohol withdrawal delirium, alcohol withdrawal symptoms, serious adverse events | - | None of the studies identified by the review assessed these outcomes |
Anticonvulsants versus antipsychotics | ||
Alcohol withdrawal seizures (mean follow‐up 10 days) | No statistically significant difference | Moderate |
Overall adverse events (mean follow‐up 10 days) | No statistically significant difference | Low |
Withdrawals due to adverse events | No statistically significant difference | Moderate |
Alcohol withdrawal delirium, alcohol withdrawal symptoms, serious adverse events | - | None of the studies identified by the review assessed these outcomes |
Note The Cochrane systematic review underlying this Cochrane Clinical Answer (CCA) notes that of the four treatments considered, benzodiazepines were the only one that showed a statistically significant benefit against alcohol withdrawal symptoms, especially seizures, when compared with placebo. However, they also state that due to heterogeneity and a lack of evidence on potential harms, “no definite conclusions about the effectiveness and safety of benzodiazepines were possible” and that further research is required. ᵃ The CCA which underpins this evidence table also includes data for gamma-hydroxybutyric acid. This intervention is not included here since it is not a recommended treatment in this BMJ Best Practice topic. Please see the full CCA for more information.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- How do different pharmacological interventions compare for the treatment of alcohol withdrawal syndrome?
- What are the effects of benzodiazepines in people with alcohol withdrawal?
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