A Scoping Review of Benzodiazepine Dosing Regimens for Adults Experiencing Moderate-to-Severe Alcohol Withdrawal...

Benzodiazepines have been established as a safe and efficacious treatment option for Alcohol Withdrawal Syndrome (AWS). The applicability of current evidence for the management of AWS in the acute hospital setting with benzodiazepines is not clear. This review sought to capture efficacy and safety outcomes for benzodiazepine use within acute hospital settings in those experiencing moderate-severe AWS symptoms.

Cochrane Registry, Medline, Embase and APA PsycInfo were searched for studies published between 2000 and 2025. Adult patients experiencing at least moderate severity AWS symptoms and treated with benzodiazepines in an acute hospital setting were included. Efficacy and safety outcomes were extracted and subsequently analysed.

There were 603 articles imported for screening, of which 24 met inclusion criteria for data extraction. There was significant heterogeneity between studies. The most common efficacy outcomes assessed were total cumulative benzodiazepine dose (20 studies); length of stay (ED, hospital admission or equivalent) (19 studies) and use of adjunct medication(s) (12 studies). The most common safety outcomes assessed were need for intubation/respiratory failure (12 studies); Occurrence of seizure (11 studies); need for ICU/higher level care (nine studies) and occurrence of delirium/DT (nine studies).

Current evidence lacks uniformity in reported outcomes and inclusion/exclusion criteria such that there is insufficient data to readily apply current evidence to the acute hospital setting for the selected population. Higher level evidence is required for future research. Prospective studies in this area should be in the form of randomised-controlled trials with pre-defined cohorts and treatment parameters.