Clinical Scenario: 30 yo M with hx of EOTH abuse BIBA after being found on the street, reports drinking alcohol a few hours ago. At bedside, patient appears tremulous and vital signs are notable for tachycardia and hypertension. You are concerned about alcohol withdrawal and ask the nurse to give the patient a benzodiazepine. How do you decide which benzo to give?
Adapted from Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e, 2016; Table 183-1
| Generic Name | Time to Peak Effect | Elimination Half-Life | Duration of Action | Active Metabolite Half-Life | Oral Dose Equivalents in Milligrams to Diazepam 10mg |
| Midazolam
(short acting) |
IV 1-2 min | 3-6 hours | IV 2 hours | Yes | 5 |
| IM 10-15 min | IM 4-6 hours | ||||
| PO 30 min-1 hour | PO 4-6 hours | ||||
| Lorazepam
(intermediate acting) |
IV 5-20 min | 9-16 hours | 6-8 hours | No | 1 |
| IM 20-30min | |||||
| PO 30 min-1 hour | |||||
| Diazepam
(long acting) |
IV 1-5 min | 20-50 hours | IV 15min-1 hour | Yes (36-200 hours) | 10 |
| PO 15-45min | PO 12-24 hours | ||||
| Chlordiazepoxide
(long acting) |
PO 2 hours | 5-30 hours | 5-30 hours | Yes (36-200 hours) | 25 |
Want to read more?
Bernstein E, Bernstein JA, Weiner SG, D'Onofrio G. Substance Use Disorders. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e New York, NY: McGraw-Hill; 2016. http://accessmedicine.mhmedical.com/content.aspx?bookid=1658§ionid=109448503. Accessed January 19, 2018.
Quan D. Benzodiazepines. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e New York, NY: McGraw-Hill; 2016. http://accessmedicine.mhmedical.com/content.aspx?bookid=1658§ionid=109414024. Accessed January 19, 2018.