1Chitkara College of Pharmacy, Chitkara University, 140401, Punjab, India
2Government Medical College and Rajindra Hospital, Patiala, Punjab, India
Background: Alcohol withdrawal syndrome (AWS) is a common and potential serious complication of abrupt cessation of chronic alcohol consumption, marked by autonomic hyperactivity, neuropsychiatric symptoms, and the possibility of seizures or delirium. Benzodiazepines remain conventional therapy but are limited by oversedation, respiratory depression, and overuse. Emerging evidence suggests the brain renin-angiotensin system plays a crucial role in addiction biology. Telmisartan, a brain-penetrant angiotensin receptor blocker with partial PPARγ agonism, may affect neuroinflammation and dopaminergic transmission, suggesting its potential efficacy as an adjuvant treatment for AWS.
Methods: We conducted a prospective, randomized, open label study in people with AWS. Participants were randomly assigned to receive either chlordiazepoxide, telmisartan, or a combination of both for seven days, with standardized supportive care. CIWA-Ar was used to assess withdrawal intensity from baseline to Day 12. Secondary outcomes included short term abstinence, craving value, and biochemical investigation. ANOVA and chi-square test were used, and the analyses were performed in GraphPad Prism version 10.5.
Results: The combination arm experienced a significantly higher mean reduction in CIWA-Ar scores (about 11 points compared to 9 points with chlordiazepoxide and 7 points with telmisartan; p<0.01). Combination therapy resulted in stronger short-term abstinence and lower craving scores at follow-up. Telmisartan containing regimens were more likely to cause hypotension, whereas benzodiazepines caused excessive sedation.
Conclusion: Adjunctive telmisartan with chlordiazepoxide decreased symptoms and short-term drinking without causing significant safety concerns; larger blinded multicentre trials are required.
Keywords: Alcohol withdrawal syndrome (AWS), Telmisartan, Chlordiazepoxide, CIWA-Ar Scale, Renin-Angiotensin System (RAS), Alcohol Craving, Angiotensin II Type 1 Receptor (AT1R)
How to cite this article: Gupta T, Das S, Maity P, Kumari P, Singh R, Goyal S. Efficacy and Safety of Telmisartan as Adjunctive Therapy in Alcohol Withdrawal Syndrome: A Randomized, Open-Label Controlled Trial. Int J Drug Deliv Technol. 2026;16(10s): 248-259; DOI: 10.25258/ijddt.16.10s.37
Source of support: Nil.
Conflict of interest: None