Pharmacopsychiatry 2006; 39(1): 30-34
DOI: 10.1055/s-2006-931479
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Efficacy and Safety of Outpatient Alcohol Detoxification with a Combination of Tiapride/Carbamazepine: Additional Evidence

M. Soyka1 , F. Schmidt1 , 2 , P. Schmidt1
  • 1Psychiatric Hospital, University of Munich, Nussbaumstr. 7, 80336 Munich, Germany
  • 2Klientenzentrierte Problemberatung Dachau, Münchner Str. 33, 85221 Dachau, Germany
This study was supported by an unrestricted educational grant by the pharmaceutical company Sanofi-Aventis
Further Information

Publication History

Received: 18.7.2005 Revised: 13.9.2005

Accepted: 10.10.2005

Publication Date:
02 February 2006 (online)

Background: Few medications have been tested for outpatient alcohol detoxification. Previously we had shown a combination of carbamazepine and tiapride to be effective in an open study. This database is an extension of our previous work. Methods: This was an open prospective study to examine the efficacy, practicability and medical safety of a combination of tiapride and carbamazepine in outpatient detoxification of alcohol dependent patients. Patients were carefully screened for relevant neuropsychiatric disorders and then seen on a daily outpatient basis. Results: A total number of 116 consecutively admitted patients entered the programme; 107 (92 %) successfully ended the treatment. The mean initial dose for tiapride was 289 mg and for carbamazepine 502 mg. No serious medical complications or adverse events were observed except for one case of delirium tremens. Only four patients dropped out because of side effects. In general medication was well tolerated. Withdrawal symptomatology as indicated by CIWA-A-scores decreased over time. Conclusions: Results from this study give further evidence for a combination of tiapride and the anticonvulsant carbamazepine as an effective and safe treatment for outpatient alcohol detoxification in patients with moderate severity of withdrawal syndrome. Further randomized trials are warranted to examine the efficacy of this combination in outpatient alcohol withdrawal.


  • 1 Agricola R, Mazzarino M, Urani R. Treatment of acute alcohol withdrawal syndrome with carbamazepine: A double blind comparison with tiapride.  J Intern Med Res. 1982;  10 160-165
  • 2 Albani F, Riva R, Baruzzi A. Carbamazepine clinical pharmacology: a review.  Pharmacopsychiatry. 1995;  28 235-244
  • 3 Allain H, Dauzenberg P H, Maurer K, Schuck S, Bonhomme D, Gerard D. Double blind study of tiapride versus haloperidol and placebo agitation and aggressiveness in elderly patients with cognitive impairment.  Psychopharmacology. 2000;  148 361-366
  • 4 Alterman A I, Bedrick J, Cacciola J S. et al . Personality pathology and drinking in young men at high and low familail risk for alcoholism.  J Stud Alcohol. 1998;  59 495-502
  • 5 Bjorkquist S E, Isohanni M, Makela R. et al . Ambulant treatment of alcohol withdrawal symptoms with carbamazepine: a formal multicentre double-blind comparison with placebo.  Acta Psychiatr Scand. 1976;  53 333-342
  • 6 Blundell R D. Ambulatory Detoxification of patients with Alcohol Dependence.  Am Fam Physician. 2005;  71 495-502
  • 7 Bonnet U, Ranger M, Leweke F M, Maschie M, Kowalski T, Gastpar M. Treatment of Alcohol Withdrawal Syndrome with Gabapentin.  Pharmacopsychiatry. 1999;  32 107-109
  • 8 Collins M N, Burns T, Van den Berk P AH, Tubman G F. A structured Programme for Out-patient Alcohol Detoxification.  Br J Psychiatry. 1990;  56 871-874
  • 9 Croissant B, Scherle T, Diehl A, Heinz A, Mann K. Oxcarbazepine in Alcohol Relapse Prevention.  Pharmacopsychiatry. 2004;  37 306-307
  • 10 Feldman D J, Pattison E M, Sobell L C. et al . Out-Patient alcohol detoxification: initial findings on 564 patients.  Am J Psychiatry. 1975;  132 407-412
  • 11 Flygenring J, Hansen J, Holst B, Petersen E, Sorensen A. Treatment of alcohol withdrawal symptoms in hospitalized patients. A randomized, double-blind comparison of carbamazepine (Tegretol) and barbital (Diemal).  Acta Psychiatr Scand. 1984;  69 398-408
  • 12 Franz M, Dlabal H, Kunz S, Ulferts J, Gruppe H, Gallhofer B. Treatment of alcohol withdrawal: tiapride and carbamazepine versus clomethiazole. A pilot study.  Eur Arch Psychiatry Clin Neurosci. 2001;  251 185-192
  • 13 Gartenmeier A, Pelzer E, Soyka M. Treatment of alcohol withdrawal syndrome with combined carbamazepine and tiapride in a patient with probable sleep apnoea syndrome.  Pharmacopsychiatry. 2005;  3 96-98
  • 14 Gottesleben A, Willemsen D, Wolf C. Retardiertes Carbamazepin in der Therapie des alkoholischen Prädelirs.  Akt Neurol. 1995;  22 60-65
  • 15 Hayashida M, Alterman A I, McLellan T. et al . Comparative effectiveness and costs of inpatient and outpatient detoxification of patients with mild-to-moderate alcohol withdrawal syndrome.  N Engl J Med. 1989;  320 358-365
  • 16 Johnson B A. An overview of the development of medications including novel anticonvulsants for the treatment of alcohol dependence.  Expert Opin Pharmacotherapy. 2004;  5 1943-1955
  • 17 Johnson B A, Ait-Daoud N, Bowden C L, DiClemente C C, Roache J D, Lawson K, Javors M A, Ma J Z. Oral topiramate for treatment of alcohol dependence: a randomized controlled trial.  Lancet. 2003;  361 1677-1685
  • 18 Jonasch K, Mende M. Treatment of Alcohol Withdrawal with Tiapride (TiapridexR) vs. Clomethiazol (DistraneurinR). An Open-Label trial (in German).  Krankenhauspsychiatrie. 2004;  15 114-116
  • 19 Lepola U, Kokko S, Nuutila J, Gordin A. Tiapride and chlordiazepoxide in acute alcohol withdrawal. A controlled clinical trial.  International J Clin Pharm Res. 1984;  5 321-326
  • 20 Lucht M J, Kuehn K U, Schroeder W, Armbruster J, Abraham G, Schattenberg A, Gaensicke M, Barnow S, Tretzel H, Herrmann F H, Freyberger H J. Influence of the dopamine D2 receptor (DRD2) exon 8 genotype on efficacy of tiapride and clinical outcome of alcohol withdrawal.  Pharmacogenetics. 2001;  11 647-653
  • 21 Lucht M, Kuehn K U, Armbruster J, Abraham G, Gaensicke M, Barnow S, Tretzel H, Freyberger H J. Alcohol withdrawal Treatment in intoxicated Vs Non-Intoxicated patients: A controlled open-label Study with Tiapride/Carbamazepine, Clomethiazole and Diazepam.  Alcohol Alcohol. 2003;  38 168-175
  • 22 Majumdar S K. Chlomethiazole: Current status in the treatment of the acute ethanol withdrawal syndrome.  Drug Alcohol Depend. 1990;  27 201-207
  • 23 Malcolm R, Myrick H, Brady K T, Ballenger J C. Update on anticonvulsants for the treatment of alcohol withdrawal.  Am J Addict. 2001;  10 (Suppl.) 16-23
  • 24 Malcolm R, Myrick H, Roberts J, Wang W, Anton R F, Ballenger J C. The effects of carbamazepine and lorazepam on single versus multiple previous alcohol withdrawals in an outpatient randomized trial.  J Gen Intern Med. 2002;  17 349-355
  • 25 Malcolm R, Ballenger J C, Sturgis E T, Anton R A. Double-blind controlled trial comparing carbamazepine to oxazepam treatment of alcohol withdrawal.  Am J Psychiatry. 1989;  146 617-621
  • 26 Mariani J J, Levin F R. Pharmacotherapy for Alcohol-Related Disorders: What Clinicians Should Know.  Harv Rev Psychiatry. 2004;  23 351-366
  • 27 Mayo-Smith MF for the American Society of Addiction M edicine, Working Group on Pharmacological Management of Alcohol W ithdrawal. Pharmacological Management of Alcohol Withdrawal. A Meta-analysis and Evidence-Based Practice Guideline.  JAMA. 1997;  278 144-151
  • 28 Mayo-Smith M F, Beecher L H, Fischer T L, Gorekick D A, Guillaume J L, Hill A, Jara G, Kasser C, Melbourne J. Management of Alcohol Withdrawal Delirium. An Evidence-Based Guideline.  Arch Intern Med. 2004;  164 1405-1412
  • 29 Mueller T I, Stout R L, Rudden S, Brown R A, Gordon A, Dolomon D A, Recupero P R. A double-blind, placebo-controlled pilot study of carbamazepine for the treatment of alcohol dependence.  Alcohol Clin Exp Res. 1997;  21 86-92
  • 30 Murphy D J, Shaw G K, Clarke I. Tiapride and chlormethiazole in alcohol withdrawal: a double-blind trial.  Alcohol Alcohol. 1983;  18 227-237
  • 31 O’Connor P G, Gottlieb L D, Kraus M L, Segal S R, Horwitz R I. Social and clinical features as predictors of outcome in outpatient alcohol withdrawal.  J Gen Intern Med. 1991;  6 312-316
  • 32 Palsson A. The efficacy of early chlormethiazole medication in the prevention of delirium tremens. A retrospective study of the outcome of different drug treatment strategies at the Helsingborg psychiatric clinics, 1975-1980.  Acta Psychiatr Scand. 1986;  73 (Suppl. 329) 140-145
  • 33 Peters D H, Faulds D. Tiapride. A review of its pharmacology and therapeutic potential in the management of alcohol dependence syndrome.  Drugs. 1994;  47 1010-1032
  • 34 Ritola E, Malinen L. A double-blind comparison of carbamazepine and clomethiazole in the treatment of alcohol withdrawal syndrome.  Acta Psychiatr Scand. 1981;  64 254-259
  • 35 Robert P H, Allain H. Clinical management of agitation in the elderly with tiapride.  Eur Psychiatry. 2001;  16 42s-47
  • 36 Rubio G, Ponce G, Jime’nez-Arriero M A, Palomo T, Manzanares J, Ferre F. Effects of Topiramate in the Treatment of Alcohol Dependence.  Pharmacopsychiatry. 2004;  37 37-40
  • 37 Scatton B, Cohen C, Perrault G, Oblin A, Claustre Y, Schoemaker H, Sanger D J, Rouquier L, Porsolt R. The preclinical pharmacologic profile of tiapride.  Eur Psychiatry. 2001;  16 29s-34
  • 38 Seifert J, Peters E, Kahn K, Metzner C, Ohlmeier M, Te Wildt B, Emrich H M, Schneider U. Treatment of alcohol withdrawal: chlormethiazole vs. carbamazepine and the effect on memory performance - a pilot study.  Addict Biol. 2004;  9 43-51
  • 39 Shaw G K, Majumdar S K, Waller S, MacGarvie J, Dunn G. Tiapride in the long-term management of alcoholics of anxious or depressive treatment.  Br J Psychiatry. 1987;  150 164-168
  • 40 Shaw G K, Waller S, Majumdar S K, Alberts J L, Latham C J, Dunn G. Tiapride in the prevention of relapse in recently detoxified alcoholics.  Br J Psychiatry. 1994;  165 515-523
  • 41 Soyka M, Morhart-Klute V, Horak M. A combination of carbamazepine/tiapride in outpatient alcohol detoxification. Results from an open clinical study.  Eur Arch Psychiatry Clin Neurosci. 2002;  252 197-200
  • 42 Soyka M, Horak M, Löhnert B, Löhnert E, Rüster P, Möller H J. Ambulante Entgiftung Alkoholabhängiger - Ein Modellversuch.  Nervenheilkunde. 1999;  8 147-152
  • 43 Soyka M, Clausius N, Hohendorf G, Horak M. Outpatient detxofication with carbamazepine and tiparide - medical safety and results of a follow-up study (in German).  Suchtmed. 2004;  6 307-311
  • 44 Stinnett J L. Outpatient detoxification of the alcoholic.  Int J Addict. 1982;  17 1031-1046
  • 45 Stockwell T, Bolt E, Hooper J. Detoxification from alcohol at home managed by general practitioners.  Br Med J. 1986;  292 733-735
  • 46 Stuppaeck C H, Barnas C, Hackenberg K, Miller C H, Fleischhacker W W. Carbamazepine monotherapy in the treatment of alcohol withdrawal.  Int Clin Psychopharmacol. 1990 ;  5 273-278
  • 47 Stuppaeck C H, Barnas C, Falk M, Guenther V, Hummer M, Oberbauer H, Pycha R, Whitworth A B, Fleischhacker W W. Assessment of the alcohol withdrawal syndrome-validity and reliability of the translated and modified clinical institute withdrawal assessment for alcohol scale (CIWA-A).  Addiction. 1994;  89 1287-1292
  • 48 Stuppaeck C, Pycha R, Miller C, Whitworth A, Oberbauer H, Fleischhacker W. Carbamazepine versus oxazepam in the treatment of alcohol withdrawal: a double-blind study.  Alcohol Alcohol. 1992;  27 153-158
  • 49 Sullivan J T, Sykora K, Schneiderman J, Neranjo C A, Sellers E M. Assessment of alcohol withdrawal: the revised clinical institute withdrawal scale (CIWA-Ar).  Br J Addict. 1989;  84 1353-1357
  • 50 Thome J, Wiesbeck G A, Vince G H. Carbamazepin in der Behandlung des Alkoholentzugssyndroms - Eine Übersicht zum aktuellen Forschungsstand.  Fortschr Neurol Psychiat. 1994;  62 125-133
  • 51 Webb M, Unwin A. The outcome of outpatient withdrawal from alcohol.  Br J Addict. 1988;  83 929-934
  • 52 Whitfield C L, Thompson G, Lamb A, Spencer v, Pfeifer M, Browning-Ferrando M. Detoxification of 1,024 alcoholic patients without psychoactive drugs.  JAMA. 1978;  239 1409-1410
  • 53 WHO. Internationale Klassifikation psychischer Störungen ICD-10 Kapitel V (F) Forschungskriterien. Dilling H, Mombour W, Schmidt MH, Schulte-Warkwort E, eds Huber Bern; 1994
  • 54 Williams D, BcBride A J. The drug treatment of alcohol withdrawal symptoms: a systematic review.  Alcohol Alcohol. 1998;  33 103-115
  • 55 Wiseman E J, Henderson K L, Briggs M J. Individualized treatment for outpatients withdrawing from alcohol.  J Clin Psychiatry. 1998;  59 289-293
  • 56 Wojnar M, Bizon Z, Wasilweski D. The role of somatic disorders and physical injury in the development and course of alcohol withdrawal delirium.  Alcohol Clin Exp Res. 1999;  23 209-213

Prof. Dr. M. Soyka

Psychiatric Hospital

University of Munich

Nussbaumstr. 7

80336 Munich


Phone: +49 89 5160 277

Fax: +49 89 5160 5617