Diphenylhydantoin and Alcohol Withdrawal

To the Editor. — Finer (215:119, 1971) advances the use of diphenylhydantoin for the treatment of alcohol withdrawal, claiming that it is effective in preventing nonepileptic alcoholic seizures when administered with or without diazepam. Alcohol withdrawal presents clinically a difficult syndrome to manage and one which evidences a high mortality unless properly treated.1,2Although a wide variety of therapies have been advanced for its treatment, seldom have such therapies been subjected to careful clinical evaluation. Where such evaluation has been attempted only drugs pharmacologically related to ethanol, ie, sedative-hypnotic drugs, have been found to be uniformly effective.3,4Such drugs can be thought to substitute for ethanol, just as ethanol can substitute for barbiturates.5Other drugs such as promazine have been found to alleviate or mask some of the less-serious symptoms of alcohol withdrawal without effectively controlling the seizures, hallucinations, and hyperthermia, with resulting higher mortalities.3,4,6