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Two chronic alcoholics who had cardiac arrests (one fatal) while receiving chlormethiazole by infusion are reported. Although a causal relationship has not been indisputably established, caution is advised when administering this drug to chronic alcoholics during withdrawal.
To evaluate clinical effectiveness and safety of 2 different detoxification treatment protocols, a chart analysis of hospital inpatients consecutively admitted for alcohol withdrawal during one year was undertaken. Records of 33 patients receiving symptom-triggered treatment (using a modified version of the revised Clinical Institute Withdrawal Assessment for Alcohol Scale) were compared with those of patients treated by applying a fixed-dose regimen (n = 32). Patients (45.3 +/- 9.8 years, 21% female) of both groups were comparable regarding illness severity, epidemiologic parameters as well as complications during the observed treatment period. Under symptom-triggered therapy, chlormethiazole (CMZ) treatment duration (4.2 +/- 3.5 vs. 7.5 +/- 3.3 days, Mann-Whitney U test: p = 0.0003) and cumulative CMZ dosage (4352 +/- 4589 vs. 9921 +/- 6599 mg, Mann-Whitney U test: p = 0.0004) were significantly reduced. The daily CMZ dose was significantly lower at days 1-5 in the group receiving symptom-triggered treatment. There was no influence of age on the outcome parameters of either treatment group. In conclusion, an individualized symptom-triggered treatment of alcohol withdrawal with CMZ seems to be equally safe but more efficient than a scheduled regimen.
The sleep-inducing properties and tolerance of temazepam formulated in solution in soft gelatine capsules were compared with chlormethiazole syrup in two groups of geriatric in-patients. Both compounds appeared to be safe, effective and well-tolerated, but significant differences in favour of temazepam were observed in quality and duration of sleep, ease of awakening and carry-over effects. This formulation of temazepam (Euhypnos) would appear to be an ideal sleep-inducer for geriatric patients.
Intravenous chlormethiazole is widely used for its sedative and anticonvulsant action in patients with acute alcohol withdrawal, status epilepticus, pre-eclampsia and eclampsia. Concern remains over its safety if it is given carelessly and without careful monitoring.
Opsoclonus is a very rare ocular dyskinesia associated to a viral infection or neoplasms, being neuroblastoma in children or carcinoma in adults. A case of opsoclonus as a paraneoplastic symptom preceding the diagnosis of breast carcinoma is presented. The abnormal movements had a complete response to the administration of chlormethiazole.
Epilepsy is an important problem in the period immediately following intracranial surgery. Rapid control of seizures is important to prevent damage to cerebral neuronal function. A method of managing epilepsy using intravenous chlormethiazole is reported. This regimen has proved to be safe and rapidly effective in the control of post-operative seizures.
Two groups of gerbils were trained to discriminate between either 2 g/kg of ethanol (ETOH) and saline or 2 g/kg of ETOH and 1 g/kg of ETOH. Acetaldehyde and a combination of cyanamide, an aldehyde dehydrogenase inhibitor, plus ETOH were tested to determine if augmented levels of acetaldehyde would enhance ETOH-like responses. The CNS depressant drug chlormethiazole (CMZ) was also tested, separately and in combination with ETOH. The effects of ETOH and acetaldehyde were also tested in an open-field (O--F). Some effect of acetaldehyde (ED50 = 160 mg/kg) was observed in the group trained to discriminate between saline and 2 g/kg of ETOH (ED50 = 800 mg/kg) but not in the group trained to discriminate between 1 and 2 g/kg ETOH. Cyanamide (50 mg/kg) given before 1 g/kg of ETOH did not markedly change the amount of ETOH (2 g/kg) appropriate responses as compared to the saline control. The percentage of ETOH (2 g/kg) appropriate choices increased after testing combinations of CMZ and ETOH as compared to testing either drug separately. ETOH stimulated ambulation (horizontal locomotor activity), whereas acetaldehyde resulted in a dose related decrease of all the behaviour patterns recorded in the O--F test. The major conclusions from these studies are that the behavioural pharmacology of acetaldehyde differs from that of ETOH, that acetaldehyde plays only a limited role in the discriminative stimulus effects of ethanol in gerbils, and that the stimulus effects of ETOH and CMZ are additive.
The equal legal of prescription of Chlormethiazol and a combination of Methophenazin and Chlordiazepoxid is demonstrated by a catamnestic examination of 52 patients with predelirant syndroms. In this way it will be shown a practicable way of an efficiently used of medicine treatment by patients with a predelirant syndrom in the out-patient department of practitioners and nerve specialists.
Chlormethiazole is an extremely useful and flexible drug for use in the management of acute alcohol withdrawal. It is not a treatment for alcohol abuse and should not be used in this patient group, other than in the withdrawal period, and then for less than 10 days. It is extremely safe when used correctly by practitioners familiar with its properties. Problems can arise, however, if used by practitioners unaware of its limitations and the precautions needed for safe prescribing.
A new anaesthesia, through Chlormethiazol i.v. is described, which is especially used in cataract (lens) operations. There is no excitation during induction and the depth of anaesthesia (stage) depends on dosage-time ratio. Recovery is calm without undesirable side-effects. The intraocular pressure is significantly diminished during anaesthesia.
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