Prevalence of Patients Admitted to Intensive Care After Administration of Chlordiazepoxide in the Emergency Room

Abstract

Chlordiazepoxide is effective in treating alcohol withdrawal syndrome, but it poses a risk of long-term sedation. The prevalence of this side effect and its risk factors remain uncertain. This retrospective cross-sectional study aimed to estimate both using data from Aarhus University Hospital's BI portal. We identified and manually reviewed patient records from 1 September 2019 to 31 August 2021, including the treating physicians' conclusions on ICU admissions to determine whether they were likely due to chlordiazepoxide toxicity. Chlordiazepoxide was administered to 1363 unique patients in the study period. We identified 32 ICU admissions preceded by chlordiazepoxide administration, 5 of which (16%) were likely related to chlordiazepoxide toxicity. Patients with chlordiazepoxide-induced admissions received higher cumulative doses compared to other admissions (425 mg vs. 150 mg, p = 0.01), had longer ICU stays (median 8 vs. 2 days, p = 0.01) and required higher doses of flumazenil (p = 0.04). Their median age was above 60 years, and not all had known liver disease. The overall incidence of long-term chlordiazepoxide toxicity was approximately 0.35%, with risk factors including higher doses and age above 60. Our findings suggest increased caution when treating not only patients with liver disease but also elderly patients with chlordiazepoxide for alcohol withdrawal symptoms.