The cornerstone of the management of AWS is administration of sedative-hypnotic xenobiotics, most notably, benzodiazepines. The use of sedative-hypnotics in AWS is logical, given the psychomotor agitation that develops with severe symptoms. As central GABAA agonists, benzodiazepines directly address the underlying pathophysiology of the GABAA receptor driving alcohol withdrawal. A landmark study in 1969 compared chlordiazepoxide, hydroxyzine, thiamine, chlorpromazine, and placebo. Chlordiazepoxide was associated with the lowest incidence of DT and alcohol withdrawal seizures.28 Two Cochrane reviews concluded that benzodiazepines are effective in the management of alcohol withdrawal.11,12
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