Excessive long term alcohol consumption can lead to dependence on alcohol. This means that when a person stops drinking suddenly he or she experiences withdrawal symptoms. The main goals for clinical management of alcohol withdrawal are to minimize the severity of symptoms and facilitate entry into a treatment program so that the person can achieve and maintain abstinence from alcohol.
Symptoms of withdrawal range from tremor, nausea, anxiety, restlessness and insomnia to a more severe form with seizures, hallucinations, agitation and delirium. Progression to coma and cardiac arrest is possible.
Medications include benzodiazepines, anticonvulsants and gamma-hydroxybutyrate, which was first available as a health food and body-building supplement. Reports of adverse events led to its withdrawal for that purpose.
Thirteen randomised controlled trials involving 648 participants were included in this review. Eleven were conducted in Italy. Six trials with a total of 286 participants evaluated the effectiveness of gamma-hydroxybutyric acid (GHB) in reducing withdrawal syndrome. Single studies showed that GHB could reduce withdrawal symptoms when compared to a placebo and Chlormethiazole but with more side effects. No strong differences were observed between GHB and benzodiazepines. In the other comparisons the differences were not statistically significant.
Seven trials involving 362 participants tested the use of GHB to treat alcohol dependence or prevent relapses if a person was already detoxified (mid-term outcomes). GHB was better than naltrexone and Disulfiram in maintaining abstinence and had a better effect on craving than placebo and Disulfiram. Sample sizes in individual trials were generally small (range 17 to 98 participants). The most consistently reported side effect of GHB was dizziness and vertigo, which was clearly dose dependent.
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