Combined Carbamazepine and Tiapride for Alcohol Withdrawal

Combined treatment with the antiepileptic carbamazepine and the dopamine antagonist tiapride may be effective for mild-to-moderate alcohol withdrawal. In this retrospective descriptive study, researchers reviewed medical records at 5 psychiatric hospitals and identified 540 patients admitted for alcohol detoxification and treated with the combination of carbamazepine and tiapride.

Treatment dosage and frequency varied (e.g., average of 543 mg carbamazepine and 796 mg tiapride on day 1; 680 mg and 1035 mg, respectively, on day 2; and tapered doses through day 10). Twenty-eight percent of subjects ended treatment prematurely.

• Nineteen percent of subjects had prior alcohol withdrawal delirium, and 28% had a prior alcohol withdrawal seizure.
• During treatment, 2% had delirium, and 1% had seizure. Eight percent experienced medication side effects, whereas 2% showed no improvement.
• Scores on the Clinical Institute Withdrawal Scale – Alcohol, used to assess withdrawal, averaged 12.3 (moderate withdrawal) on day 1 of treatment and gradually decreased to 2.6 on day 9.

Comments:

In this study, the incidences of alcohol withdrawal delirium and seizure were relatively low even though a substantial minority of patients reported having had these complications previously. However, whether the low occurrence of complications was due to combined carbamazepine and tiapride cannot be ascertained from this study because of the lack of a control group and uncertainty about how patients were selected to receive the therapy. Randomized trials are necessary to determine if combining carbamazepine and tiapride is superior or even equally efficacious to standard benzodiazepine therapy.

Kevin L. Kraemer, MD, MSc

Reference:

Soyka M, Schmidt P, Franz M, et al. Treatment of alcohol withdrawal syndrome with a combination of tiapride/carbamazepine: results of a pooled analysis in 540 patients. Eur Arch Psychiatry Clin Neurosci. 2006;256(7):395–401.