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Sir,

I would like to respond to the queries raised by the author regarding our article published in the IJP titled "cost-effectiveness analysis of baclofen and chlordiazepoxide in uncomplicated alcohol-withdrawal syndrome." [1]

The concern raised by the author was regarding the finding from Amato et al. study indicating "effect of chlordiazepoxide being still inconclusive" with "great concern on the adverse effect." [2] Benzodiazepines, such as diazepam and chlordiazepoxide, despite their adverse effects, are still considered first line drugs to be used in alternative work schedules (AWS) worldwide as they can control the withdrawal effects very effectively compared to other available alternative medications. [3],[4] Amato et al. in their 1996 study could not establish definite conclusions regarding effectiveness and safety of benzodiazepines "because of the heterogeneity of the trials both in interventions and in the assessment of outcomes." Data on potential adverse effects were also "sparse and fragmented." [2]

Although research is ongoing to find better alternatives for the management of AWS, only some drugs, such as baclofen, a B gamma-aminobutyric acid agonist, have shown efficacy, at least, in uncomplicated AWS. [5] Many other drugs like topiramate, carbamazepine, clonidine, gabapentin, and calcium channel blockers including nifedipine have been tried in AWS management, but limited data exists on their effectiveness in managing AWS. [2] It is pertinent to note here that all adverse events and costs incurred in the management were considered for cost-effective analysis" in our study. [1]

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