In response to: Safety and Efficacy of Flumazenil for Reversal of Iatrogenic Benzodiazepine-Associated Delirium Toxicity During Treatment of Alcohol Withdrawal, a Retrospective Review at One Center

摘要

We read with interest the paper by Moore et al. [1] assessing the use of flumazenil for reversal of iatrogenic benzodiazepine-associated delirium in alcohol withdrawal. Alcohol withdrawal is associated with significant morbidity and requires extensive resource utilization for patient management. While we acknowledge that the treatment ofpatients with alcohol withdrawal can result in iatrogenic benzodiazepine overdose, this adverse effect can be limited by symptom-triggered administration of benzodiazepines, which is perhaps the most widely accepted and evidencebased approach to therapy [2]. The retrospective and uncontrolled nature of the data presented by the authors suggests substantial deviations from this approach and includes other departures from commonly accepted care such as the use of multiple benzodiazepines, neuroleptics, opioids, and a host of other drugs. Patient selection is unclear and the dosing and indications for benzodiazepines are unspecified.