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No clear efficacy advantage was found for either drug. In this randomized study of 60 men with alcohol dependence syndrome and CIWA-Ar scores below 15, lorazepam and diazepam produced nearly identical improvement in withdrawal symptoms. Mean CIWA-Ar scores fell from 11.07 to 0.13 with lorazepam and from 10.9 to 0 with diazepam over 12 weeks, and the overall reduction was almost the same (−10.93 vs −10.9; P = .960).

Both drugs reduced withdrawal symptoms by more than 50% within about 5 days, with no statistically significant difference between groups. Time to greater than 50% symptom reduction was 4.97 days with lorazepam and 4.6 days with diazepam (P = .241), and both were considered equally effective in achieving that level of response (P = .214).

Neither drug showed a statistically significant advantage for anxiety reduction. HAM-A scores decreased from 2.27 to 0.17 in the lorazepam group and from 1.33 to 0 in the diazepam group over 12 weeks, with no significant between-group differences at baseline (P = .122), after detoxification (P = .327), or at 12 weeks (P = .321). The total reduction was numerically greater with lorazepam (−2.1 vs −1.33), but this difference was not significant (P = .146).

Both drugs were associated with improvement in depressive symptoms, but neither was superior. HAM-D scores fell from 2.47 to 0.27 with lorazepam and from 1.2 to 0 with diazepam over 12 weeks, with no significant between-group differences at baseline (P = .100), after detoxification (P = .079), or at 12 weeks (P = .321). The larger numerical reduction with lorazepam (−2.2 vs −1.2) was not statistically significant (P = .103).

The study used oral symptom-triggered regimens adjusted by CIWA-Ar scores and side effects. Lorazepam was started at 4 mg/day in 3–4 divided doses with 1 mg/day titration, while diazepam was started at 10 mg/day in 1–2 doses per day with 5 mg/day titration. Once withdrawal symptoms improved by 50%, the benzodiazepine was downtitrated and then gradually stopped over 3–4 weeks.

The average daily dose was 5.56 mg/day for lorazepam (SD = 1.16) and 17.14 mg/day for diazepam (SD = 4.81). The authors noted that this reflects an observed lorazepam:diazepam ratio of about 1:3 in their sample, which differs from the commonly cited equivalence of 2 mg lorazepam to 10 mg diazepam.

Most physiological and biochemical measures were similar between groups over 12 weeks, but SGPT decreased significantly more with diazepam. The between-group difference in SGPT reduction was statistically significant (P = .013), whereas other liver-related and physiological parameters did not show the same pattern. The authors stated that the reason for this isolated finding remains uncertain.

These findings apply most directly to male inpatients aged 25 years or older with alcohol dependence syndrome and relatively uncomplicated withdrawal, defined here as a CIWA-Ar score below 15. The study excluded patients with epilepsy, dependence on substances other than nicotine or caffeine, past complicated withdrawals, current intoxication, active psychotic illness, acute medical or surgical illness, and active suicidality, so the results should not be generalized to higher-risk withdrawal presentations without caution.

This was a prospective, randomized interventional study conducted at a tertiary care teaching hospital in Northern India. Eighty patients were screened, 69 were randomized, and 60 completed analysis, with 30 patients in each treatment group. Outcomes included daily CIWA-Ar ratings during detoxification and HAM-A and HAM-D assessments at baseline, after detoxification, and at 12 weeks.

The main limitations are that the study was small, conducted at a single center, and included only men, which limits generalizability. There was no nonmedicated control group, the follow-up was short-term at 12 weeks, duration of hospital stay was not evaluated, and most patients received baclofen after detoxification, which limited separate analysis of its effect on anxiety and depressive symptoms. The authors also noted that occasional as-needed benzodiazepine use after formal discontinuation could not be excluded.