From the FDA Drug Label
For anxiety, most patients require an initial dose of 2 mg/day to 3 mg/day given twice daily or three times daily. The treatment for alcohol withdrawal tremors in a patient with a heart block (atrioventricular block) is not directly addressed in the provided drug label. Key points:
- The label discusses the administration of lorazepam for anxiety and insomnia.
- It does not provide information on the treatment of alcohol withdrawal tremors.
- It does not address the specific consideration of a patient with a heart block (atrioventricular block). 1
From the Research
Treating alcohol tremors in someone with a heart block requires careful medical management under physician supervision, with benzodiazepines like lorazepam or diazepam being the first-line treatment, while avoiding beta-blockers and considering clonidine as an adjunctive therapy. The management of alcohol withdrawal syndrome (AWS) in patients with heart block, such as atrioventricular block, is crucial to prevent complications and reduce morbidity and mortality. According to the most recent study 2, benzodiazepines are the first-line therapy for moderate to severe alcohol withdrawal symptoms, due to their ability to reduce central nervous system hyperactivity. Some key points to consider in the management of AWS in patients with heart block include:
- Benzodiazepines, such as lorazepam (0.5-2mg every 4-6 hours as needed) or diazepam (5-10mg every 4-6 hours as needed), are the primary treatment for alcohol withdrawal tremors, as they help reduce central nervous system hyperactivity 3, 2.
- Beta-blockers, which might otherwise help with tremors, should be avoided as they can worsen heart block 3, 4.
- Clonidine (0.1-0.2mg every 8 hours) may be used cautiously as it treats tremors without significantly affecting cardiac conduction 3, 4.
- Thiamine (100mg daily) and multivitamin supplementation are essential to prevent Wernicke's encephalopathy 5, 6.
- Adequate hydration and electrolyte replacement (particularly magnesium and potassium) are crucial to prevent complications 5, 6.
- The patient should be monitored continuously with cardiac telemetry during treatment, as alcohol withdrawal can worsen cardiac conduction abnormalities 6. The underlying mechanism involves the nervous system's adaptation to alcohol's depressant effects; when alcohol is removed, the nervous system remains in a hyperactive state, causing tremors and potentially dangerous withdrawal symptoms that require careful management, especially in those with pre-existing cardiac conditions 3, 2.