Comparative efficacy of propranolol and chlordiazepoxide in alcohol withdrawal.

Abstract

The efficacy of propranolol and chlordiazepoxide in the treatment of the alcohol withdrawal syndrome was studied in a randomized double-blind trial involving 30 male alcoholics (aged 21-56). All subjects drank 4 g of alcohol/kg of body wt for 5 days in the hospital; then during the 6-day withdrawal phase they received 1 of the following treatments every 6 h: placebo; 25 mg of chlordiazepoxide; 40 mg of propranolol; 10 mg of propranolol; and 10 mg of propranolol and 25 mg of chlordiazepoxide. Ten healthy men served as controls. All treatments were more effective than placebo in reducing tremor, heart rate, blood pressure, 24-h urinary catecholamine excretion and plasma catecholamines by the 2nd day of withdrawal. The high dose of propranolol was the most effective treatment and reduced all of the symptoms without increasing the level of sedation. Combined treatment with propranolol and chlordiazepoxide offered no advantages over either drug administered alone. Propranolol (40 mg) every 6 h may be used alone in the treatment of mild to moderate alcohol withdrawal in selected patients. In severe withdrawal, benzodiazepines should be used initially; propranolol could be used adjunctively in patients with severe tremor or tachyarrhythmia.