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DRUG, ALCOHOL, AND SUBSTANCE ABUSE

Valproic Acid Management of Acute Alcohol Withdrawal

PharmD Student, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada

Sean K Gorman, PharmD

Clinical Assistant Professor, Faculty of Pharmaceutical Sciences, University of British Columbia; Pharmacotherapeutic Specialist, Critical Care/Trauma/General Surgery, Vancouver General Hospital, Vancouver

Richard S Slavik, PharmD

Clinical Associate Professor, Faculty of Pharmaceutical Sciences, University of British Columbia; Pharmacotherapeutic Specialist, Critical Care/Trauma/General Surgery, Vancouver General Hospital

Reprints: Dr. Gorman, CSU Pharmaceutical Sciences, Vancouver General Hospital, 855 W. 12th Ave., Vancouver, BC V5Z 1M9, Canada, fax 604/875-5267, sean.gorman{at}vch.ca

OBJECTIVE: To review the clinical evidence to determine the efficacy and safety of valproic acid in the management of alcohol withdrawal syndrome (AWS).

DATA SOURCES: MEDLINE (1966-February 2006), EMBASE (1980-February 2006), and PubMed (1966-February 2006) searches identified pertinent studies that were conducted in humans and published in English. Key words used for identification of articles included valproic acid, ethanol, alcohol, alcoholism, alcohol withdrawal delirium, alcohol withdrawal seizures, and substance withdrawal syndrome. References of identified articles were manually searched.

STUDY SELECTION AND DATA EXTRACTION: All controlled clinical trials that evaluated the use of valproic acid for the management of AWS in humans were included.

DATA SYNTHESIS: Comparisons were made among various regimens of valproic acid and traditional therapy with benzodiazepine or nonbenzodiazepine agents. Only 2 of 6 trials reported a statistically significant difference in favor of valproic acid on endpoints of AWS. However, these differences were of marginal clinical significance. The number of patients included in these studies did not allow for adequate evaluation of safety.

CONCLUSIONS: The existing limited efficacy and safety data suggest that valproic acid should not replace conventional therapy or be used as adjunct therapy for management of mild-to-moderate AWS.

Key Words: alcohol withdrawal, ethanol, valproic acid

Published Online, February 28, 2006. www.theannals.com, DOI 10.1345/aph.1G243

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