Alpha-2 Adrenergic Recipients, Valproic and Carbamazepine Acids as an Adjuvant Treatment in Moderate-Grave Alcoholic Abstinence: Systematic Review

Abstract

Alcohol dependence is among the main risk factors for health in most developed and developing countries. Therapeutic success in moderate-grave abstinence could be increased with adjuvant treatment to benzodiazepines. In our environment, agonists α-2 (clonidine and dexmedetomidine), valproic acid and carbamazepine are the most used. The objective of this work was to carry out the thorough search, critical analysis and summary of the evidence to provide an overview of the effectiveness of these drugs when used without a certain time of treatment compared to each other, against any intervention, placebo or other interventions. A bibliographic search was carried out in databases (PubMed/Medline, Lilacs, and Embase). Two reviewers selected, extracted the data and evaluated the bias risk of independently included studies using the covidence software. The disagreements were resolved by consensus. We perform meta-analysis using revman 5.3 and subgroup analysis by study design. 22 studies were included where none of them presented a risk of bias in all domains, and most studies presented at least one domain with high bias risk. Studies with statistically low results showed that dexmedetomidine and valproic acid decrease the requirements of benzodiazepines in patients receiving placebo. In addition, when valproic acid is combined with benzodiazepines achieve a stable and continuous decrease in abstinence measured in CIWA-AR scale. Clonidine was the only one described that presented a decrease in heart rate against placebo with high significance, clinical situation to be in mind in front of the sympathomimetic syndrome that characterizes alcohol withdrawal syndrome.