Key Takeaways
Extended Takeaways
- This randomized comparison was limited to relatively uncomplicated withdrawal: male inpatients aged ≥25 years with CIWA-Ar score <15, excluding epilepsy, past complicated withdrawals, active psychosis, acute medical or surgical illness, and active suicidality, so the findings are most applicable to moderate-severity detoxification rather than high-risk withdrawal.
- Baseline severity was closely matched between groups, with SADQ means of 22.73 (SD = 5.74) for lorazepam and 22.47 (SD = 3.75) for diazepam (P = .832) and CIWA-Ar means of 11.07 (SD = 2.7) and 10.9 (SD = 2.22) (P = .795), supporting a fair head-to-head efficacy comparison.
- Under the study’s symptom-triggered oral protocol, lorazepam was initiated at 4 mg/day in 3–4 divided dosages with 1 mg/day titration, while diazepam was initiated at 10 mg/day in 1–2 dosages per day with 5 mg/day titration; clinicians can use these dosing schedules as practical reference points for similar inpatient detox settings.
- Mean CIWA-Ar scores fell from 11.07 to 1.97 to 0.13 with lorazepam and from 10.9 to 1.97 to 0 with diazepam, with no between-group differences at baseline (P = .795), postdetoxification (P = .999), or 12 weeks (P = .321), indicating near-complete symptom resolution in both arms by follow-up.
- Average daily exposure was 5.56 mg/day (SD = 1.16) for lorazepam and 17.14 mg/day (SD = 4.81) for diazepam, producing an observed lorazepam:diazepam ratio of approximately 1:3 rather than the commonly cited 1:5 equivalence, which may matter when converting regimens in routine care.
- Benzodiazepines were tapered after 50% symptom relief and discontinued over 3–4 weeks, and no additional SSRIs were prescribed; in this context, mild baseline anxiety and depression improved over 12 weeks without differential benefit between agents, but the near-uniform postdetoxification use of baclofen limits attribution of later mood changes solely to the benzodiazepine choice.
