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Ronald Pies, MD
State University of New York Upstate Medical Center Syracuse

JAMA. 1981;246(14):1546.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

The report by Weddington et al, "Cimetidine Toxic Reactions Masquerading as Delirium Tremens" (1981;245:1058-1059), was informative and useful. However, the use of intramuscular chlordiazepoxide hydrochloride in the patient described raises important questions. Although a common practice, the intramuscular administration of most benzodiazepines is not the preferred route. With the exception of lorazepem, intramuscular absorption of these drugs is slow, erratic, and sometimes incomplete, probably owing to precipitation of drug at the injection site.¹ Alcoholic patients are sometimes unwilling or unable to take medications orally, but as soon as possible, they should be treated via the oral route, or by slow intravenous infusion.

It is thus difficult to say with impunity that the patient described by Weddington et al "did not respond" to 250 mg of intramuscular chlordiazepoxide; she may simply have had inadequate plasma levels owing to the route of administration. . . . [Full Text PDF of this Article]

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