From the Guidelines
The treatment for alcohol withdrawal involves a combination of medications, supportive care, and monitoring, with benzodiazepines as the first-line treatment, and thiamine administration to prevent Wernicke's encephalopathy, as recommended by the most recent guidelines 1.
Key Components of Treatment
- Benzodiazepines, such as diazepam, lorazepam, or chlordiazepoxide, are used to prevent seizures, reduce anxiety, and manage other withdrawal symptoms, with dosing adjusted based on symptom severity 1.
- Thiamine (100mg daily) should be administered to prevent Wernicke's encephalopathy, given the high prevalence of thiamine deficiency in alcohol-dependent individuals 1.
- Fluid replacement, electrolyte correction, and nutritional support are essential components of care.
- Close monitoring using the Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar) helps guide medication dosing.
Considerations for Specific Patient Populations
- In patients with advanced liver disease, a personalized prescription that is symptom-adapted and favors short-acting drugs is recommended 1.
- Short half-life benzodiazepines, such as oxazepam or lorazepam, may be preferred in cirrhotic patients to avoid drug accumulation and minimize the risk of encephalopathy 1.
Importance of Monitoring and Follow-up
- Regular monitoring is necessary to guide dosage adjustment and prevent seizures, and can be stopped after 24 hours if no specific signs appear 1.
- Following acute withdrawal management, patients should be connected with addiction treatment services for long-term recovery support.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION ... Symptomatic Relief in Acute Alcohol Withdrawal. 10 mg, 3 or 4 times during the first 24 hours, reducing to 5 mg, 3 or 4 times daily as needed INDICATIONS ... In acute alcohol withdrawal, diazepam may be useful in the symptomatic relief of acute agitation, tremor, impending or acute delirium tremens and hallucinosis
The treatment for alcohol withdrawal is diazepam (PO), with a dosage of 10 mg, 3 or 4 times during the first 24 hours, reducing to 5 mg, 3 or 4 times daily as needed 2. Diazepam may be useful in the symptomatic relief of acute agitation, tremor, impending or acute delirium tremens, and hallucinosis in acute alcohol withdrawal 2.
- Key points:
- Diazepam dosage: 10 mg, 3 or 4 times during the first 24 hours
- Reduction: reducing to 5 mg, 3 or 4 times daily as needed
- Symptomatic relief: acute agitation, tremor, impending or acute delirium tremens, and hallucinosis
From the Research
Treatment for Alcohol Withdrawal
The treatment for alcohol withdrawal typically involves the use of medications that are cross-tolerant with alcohol, such as benzodiazepines 3, 4, 5, 6, 7.
- Benzodiazepines are considered the agents of choice for treating alcohol withdrawal symptoms, including anxiety, agitation, tremors, and seizures.
- The most commonly used benzodiazepines for this purpose are lorazepam, chlordiazepoxide, oxazepam, and diazepam 3.
- Diazepam has been suggested as the preferred benzodiazepine for treating moderate to severe alcohol withdrawal due to its rapid onset of action and long elimination half-life 3, 4.
Pharmacotherapy
Pharmacotherapy for alcohol withdrawal may involve the use of other medications in addition to benzodiazepines, such as:
- Carbamazepine, which can be used as an alternative to benzodiazepines in outpatient treatment of mild to moderate alcohol withdrawal symptoms 6.
- Haloperidol, beta blockers, clonidine, and phenytoin, which may be used as adjuncts to benzodiazepines in the treatment of complications of withdrawal 6.
- Propofol, which can be used for patients who are refractory to benzodiazepines 7.
Supportive Care
Supportive care is also an essential component of treating alcohol withdrawal, including: