1018: SAFETY ANALYSIS OF BENZODIAZEPINE USAGE IN HIGH-RISK PATIENTS WITH SEVERE ALCOHOL WITHDRAWAL

Abstract

Introduction: Delirium tremens (DTs) and alcohol withdrawal (AW) seizures are severe complications of AW with significant morbidity and mortality. In those with a history of withdrawal seizures or DTs, the administration of a GABAergic agent via a symptom-triggered regimen (STR) or scheduled regimen (SR) is crucial to preventing recurrence of these events. However, some data has shown dosing frequency does not influence these AW complications. The purpose of this study was to assess the safety of STR vs SR benzodiazepine administration in relation to recurrent AW seizures or DTs in patients with severe AW in the intensive care unit (ICU). Methods: Patients were included if admitted to an ICU at our institution between January 1, 2019 and December 31, 2020 with severe AW and a history of AW seizures and/or DTs. Groups were defined based on benzodiazepine dosing schedule: STR vs SR. The primary outcome was rates of recurrent DTs or AW seizures during ICU admission. Secondary outcome(s) include total benzodiazepine exposure. Results: Of 66 encounters identified, 13 patients met inclusion criteria. Six received STR dosing and 7 received SR dosing. Baseline characteristics were similar between groups for age, sex, and race. The STR group had fewer patients with a history of DTs (66% vs 85%) and withdrawal seizures (66% vs 71%) compared to the SR group. No differences were found between groups in incidence of recurrent DTs (16.7% vs 14.3%, p=0.906) and withdrawal seizures (16.7% vs 28.6%, p=0.612). Patients in the STR group received similar median benzodiazepine doses on day 1 (4.5 mg [1 – 11.3] vs 5 mg [3 - 9]) and lower median overall benzodiazepine usage (20.8 mg [7.6 – 41.4] vs 73.5 mg [42.6 – 138]) compared to the SR group. Conclusions: No difference was found in the rate of recurrent DTs or withdrawal seizures between the two dosing groups. However, our study is limited by small sample size and retrospective design. Overall, this study showed that both symptom-triggered and scheduled benzodiazepine dosing may be both safe and effective for patients with AW and a history of DTs or withdrawal seizures.