Clinical effectiveness and safety of metadoxine in the management of acute alcohol intoxication: A single-center retrospective cohort study.

BACKGROUND

Acute alcohol intoxication (AAI) is a common emergency with no specific antidote. Metadoxine has shown potential but lacks sufficient real-world evidence, particularly in Chinese populations.

OBJECTIVES

To evaluate the clinical efficacy and safety of metadoxine in patients with acute alcohol intoxication.

METHODS

This single-center retrospective cohort study included 124 patients with AAI admitted to an emergency department between January and December 2024. Patients were divided into metadoxine plus conventional treatment (n=62) or conventional treatment alone (n=62) after propensity score matching. Primary outcomes were time to consciousness recovery (Glasgow Coma Scale ≥14) and treatment effectiveness rate (symptom improvement within 6 hours without treatment escalation). Secondary outcomes included time to symptom relief, emergency stay, time to vital sign stabilization, blood ethanol decline rate, adverse reactions, and liver function changes.

RESULTS

Metadoxine significantly shortened consciousness recovery time (3.05±1.45 vs. 5.65±1.58 hours, mean difference -2.60 hours, 95% CI: -3.14 to -2.06, p < 0.001) and improved treatment effectiveness rate (93.5% vs. 77.4%, OR=4.04, 95% CI: 1.30-12.56, p = 0.011). All secondary outcomes were significantly better in the metadoxine group (p < 0.001 for time-related outcomes and blood ethanol decline). No significant differences were observed in adverse reactions (9.68% vs. 6.45%, p = 0.510) or post-treatment liver enzyme abnormalities (12.90% vs. 16.13%, p = 0.610). Subgroup analysis showed a significant interaction by initial Glasgow Coma Scale (p = 0.037), indicating greater efficacy in patients with moderate-to-severe impairment.

CONCLUSION

Metadoxine, when added to conventional supportive therapy, significantly accelerates consciousness recovery and improves clinical outcomes in acute alcohol intoxication without increasing short-term adverse events. The benefit appears more pronounced in patients with lower Glasgow Coma Scale scores.