Manejo del síndrome de abstinencia alcohólica en los pacientes críticos / Management of the syndrome of alcohol withdrawal in critical patients

El manejo del síndrome de abstinencia alcohólica es un desafío en los pacientes críticos. Con frecuencia, se desconocen los antecedentes de consumo de alcohol o este dato es incompleto, lo que limita la identificación de quienes pueden desarrollar este síndrome. El cese abrupto del consumo de alcohol coloca a estos pacientes en alto riesgo de sufrir síndrome de abstinencia alcohólica grave. Típicamente, las benzodiacepinas son consideradas las drogas de primera línea para el manejo de estos casos. Sin embargo, si el paciente progresa a un estado más grave con convulsiones o delirium tremens, puede ser necesario administrar medicación adyuvante a las benzodiacepinas, como el propofol o la dexmedetomidina, o emplear estas últimas drogas como terapias alternativas en aquellos que no responden a las benzodiacepinas. La aparición de convulsiones representa un fuerte factor de riesgo para la progresión a un síndrome de abstinencia alcohólica grave, con el desarrollo posterior de delirium tremens hasta en el 30% de los casos. El delirium tremens es el cuadro más grave y ocurre en el 5-20% de los pacientes con este síndrome, con una mortalidad hasta del 25% sin tratamiento y que se reduce al 0-1% con tratamiento. Es importante conocer el antecedente del consumo de alcohol para evitar el síndrome de abstinencia alcohólica o tratar rápidamente sus síntomas más graves, y mejorar la supervivencia de estos pacientes.(AU)

Alcohol withdrawal syndrome (AWS) is a well-known and a challenging condition occurring in critically ill patients. Frequently, history of alcohol abuse is unknown when the patient is admitted to the intensive care unit, limiting the identification of those who could develop AWS. The abrupt cessation of a heavy or constant drinking put these patients in high risk of suffering from this syndrome in its severe form. Typically, benzodiazepines are considered the first line of treatment. However, if clinical conditions progress to epileptic seizures or delirium tremens or are refractory to benzodiazepines, adjuvant drugs like propofol or dexmedetomidine might be an option to control the severe symptoms. Delirium tremens can occur in up to 30% of patients; it is the most severe picture with a mortality of 25% without treatment and that can be reduced to almost 0-1% with treatment. It is important to appropriately identify alcohol abuse in order to avoid the early clinical manifestations of AWS or rapidly treat its most severe symptoms and improve survival.(AU)

Effect of Withania somnifera Dunal in ethanol-induced anxiolysis and withdrawal anxiety in rats.

Withania somnifera (WS) or its psychotropic preparation is known to play a critical role in morphine, alcohol and benzodiazepines addiction. This study investigates the role of WS in acute ethanol and withdrawal from chronic ethanol consumption using elevated plus maze paradigm in rats. Acute administration of ethanol (1.5-2 g/kg, ip) triggered anxiolytic effect and withdrawal from prolonged ethanol (9% v/v ethanol, 15 days) consumption elicited enhanced behavioral despair (anxiety). Acute administration of WS (50 mg/kg, oral) potentiated the anxiolytic action of subeffective dose of ethanol (0.5 or 1 g/kg, ip). Moreover, the ethanol withdrawal anxiety was markedly antagonized in dose dependent manner by WS at 200 and 500 mg/kg or higher dose of ethanol (2.5 g/kg). However, co-administration of subeffective doses of WS (50 mg/kg, oral) and ethanol also attenuated withdrawal-induced anxiety due to chronic ethanol (9% v/v ethanol, 15 days) consumption. The results suggest the protective effect of WS in the management of ethanol withdrawal reactions.

Pharmacotherapies of addiction

Millions of drug addicts worldwide require proper treatment together with good quality care. This article aims to critically review the psychopharmacology of drug addictions. MEDLINE was systematically searched for studies describing drug treatment of addictions. Numerous studies were obtained and grouped according to the drug used to treat addictions. Although there are many effective antiaddictive drugs in the therapeutic armamentarium of drug addictions, a great number of patients tend to develop poor drug compliance, multiple relapses, and continue to suffer from chronic addictions coupled with negative biopsychosocial consequences. Aside from enhancing the public awareness of the devastating effects of drug addictions through regular and effective mass media campaigns, scientific efforts should be continued in order to develop new antiaddictive drugs with better clinical profiles for the treatment of patients with addictions

Alcoolismo e benzodiazepínicos / Alcoholism and benzodiazepine

Com o intuito de estudar a açao e os efeitos dos benzodiazepínicos no tratamento do alcoolismo, foi realizado um levantamento bibliográfico sobre o assunto, com destaque para a açao do álcool e dos benzodiazepínicos no SNC, mais especificamente no sistema gabaérgico. Fazendo-se uma correlaçao farmaco-clínica, constatou-se que as síndromes de abstinência, que variam de leves a severas, como delirium tremens, sao tratadas com diversas dosagens de benzodiazepínicos obtendo-se bons resultados. Nao foi necessária, na maioria dos pacientes, a associaçao com outras drogas depressoras e sedativas.