苯二氮卓以外的戒毒困境;氯尼丁在酒精戒断治疗中的窘境。

IF 2.5 4区 医学 Q2 SUBSTANCE ABUSE American Journal on Addictions Pub Date : 2024-08-03 DOI:10.1111/ajad.13640
Matthew Johnson, Danielle Cosentino, Brian Fuehrlein
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引用次数: 0

摘要

背景和目的:苯二氮卓类药物是治疗酒精戒断的主要方法,但美国成瘾医学会的指南也将替代药物纳入考虑范围。退伍军人事务部(VA)精神科急诊室的观察结果表明,即使临床研究所酒精戒断评估(CIWA)评分较低且没有其他相关症状,也会持续使用苯二氮卓类药物,但总体上不使用替代药物。由于担心苯二氮卓类药物的使用可能超出必要范围,我们对退伍军人群体中使用氯尼丁辅助治疗酒精戒断时的血压/脉搏升高进行了分析:这是 2022 年 7 月 1 日至 2023 年 6 月 30 日期间退伍军人事务部对精神科急诊室进行的一次单一地点回顾性病历审查,重点关注根据 CIWA 方案管理的酒精戒断患者。本研究对 167 份患者病历进行了分析,其中不包括同时出现的阿片类药物戒断和作为家庭用药的氯尼替丁:结果:167 名患者中有 99 人(59.3%)合并高血压。针对 CIWA 升高(373 例,占 60.8%)和血压/脉搏升高(241 例,占 39.2%)共用药 614 次。在治疗血压/脉搏升高的 241 个剂量中,只有 2.5% 是氯硝西泮。在所有苯二氮卓类药物剂量中,75.3%用于合并高血压的患者。3.0%的患者使用了氯尼替丁,占总剂量的2.5%:讨论与结论:酒精戒断治疗缺乏优化。整合辅助用药可减少潜在的苯二氮卓类药物过度使用,有效解决血压/脉搏升高问题:本研究揭示了氯硝西泮可能存在的使用不足及其在改善酒精戒断综合征管理中的潜在作用。通过解决血压/脉搏升高问题并遏制苯二氮卓类药物的潜在过度使用,该研究可能有助于进一步优化患者护理。
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A detox dilemma beyond benzodiazepines; clonidine's quandary in alcohol withdrawal management.

Background and objectives: Benzodiazepines are the primary method of treatment of alcohol withdrawal, though the American Society of Addiction Medicine guidelines also include alternative agents for consideration. Observations in a Department of Veterans Affairs (VA) psychiatric emergency room noted consistent benzodiazepine use with an overall lack of use of alternative agents, even with low Clinical Institute Withdrawal Assessment for Alcohol (CIWA) scores and in the absence of other concerning symptoms. Due to concerns of potential more-than-necessary benzodiazepine use, we analyzed adjunctive clonidine use for elevated blood pressure/pulse in alcohol withdrawal among this Veteran population.

Methods: This is a single-site VA retrospective chart review of the psychiatric emergency room from July 1, 2022, to June 30, 2023, focused on patients with alcohol withdrawal managed on a CIWA protocol. Excluding concurrent opioid withdrawal and clonidine as home medication, 167 patient charts were analyzed for this study.

Results: Among 167 patients, 99 (59.3%) had comorbid hypertension. A total of 614 medication doses were given for elevated CIWA (373, 60.8%) and elevated blood pressure/pulse (241, 39.2%). Of the 241 doses for elevated blood pressure/pulse, only 2.5% were clonidine. Among all benzodiazepine doses, 75.3% were given to patients with comorbid hypertension. Clonidine was administered to 3.0% of patients, making up 2.5% of total dosing.

Discussion and conclusions: Alcohol withdrawal management lacks optimization. Integrating adjunctive medications could reduce potential benzodiazepine overuse effectively addressing elevated blood pressure/pulse.

Scientific significance: This study sheds light on the potential underutilization of clonidine and its potential role in improving alcohol withdrawal syndrome management. By addressing elevated blood pressure/pulse and curbing potential overuse of benzodiazepines, it may contribute to further optimizing patient care.

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来源期刊
CiteScore
5.00
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118
期刊介绍: The American Journal on Addictions is the official journal of the American Academy of Addiction Psychiatry. The Academy encourages research on the etiology, prevention, identification, and treatment of substance abuse; thus, the journal provides a forum for the dissemination of information in the extensive field of addiction. Each issue of this publication covers a wide variety of topics ranging from codependence to genetics, epidemiology to dual diagnostics, etiology to neuroscience, and much more. Features of the journal, all written by experts in the field, include special overview articles, clinical or basic research papers, clinical updates, and book reviews within the area of addictions.
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