Clomethiazole for the treatment of alcohol withdrawal syndrome: A systematic review and metanalysis

Introduction The objective of this systematic review was to estimate the efficacy and safety of chlomethiazole for the treatment of alcohol withdrawal syndrome in patients with alcohol addiction.

Methods Electronic databases were searched through March 2022 for randomized prospective controlled trials (RCTs) investigating patients with alcohol dependence admitted and treated for alcohol withdrawal syndrome. Studies in any language were considered. Comperators were separated in two groups. Group A included chlordiazepoxide, alprazolam, GHB and carbamazepine with a proven own effect on alcohol withdrawal syndrome and Group B with bromocriptine, tiapride, trifluoperazine, clonidine and piracetame with effects only on specific symptoms of withdrawal syndrome.

Results 15 RCTs were included. Clomethiazole showed a significant better response if compared to placebo (OR 3,88; 95% CI=1.95 to 7.73; p=0.0001) or to other substances in group B (OR 2.92; 95% CI= 0.99 to 9.09; p=0.06). No difference was found if compared to group A (OR 0.86; 95% CI= 0.35 to 2.11; p=0.74). Clomethiazole significantly reduced seizures during withdrawal treatment if compared to placebo (OR 0.12; 95% CI= 0.02 to 0.84; p=0.03).

Conclusion Clomethiazole has superior effects if compared to placebo regarding overall response and preventing seizures during withdrawal treatment. Response was also better if compared to other substances with effects only on specific symptoms of withdrawal syndrome. Based on the age of most trials with methodological deficiencies and the relatively low number of cases, data should be interpreted cautiously.

Publication History

Article published online:
08 November 2022