From the Guidelines
Benzodiazepines are the most effective medications for managing both anxiety disorders and alcohol withdrawal syndrome, with specific medications like diazepam, lorazepam, and chlordiazepoxide being particularly effective. These medications work by enhancing the effect of the neurotransmitter GABA in the brain, which produces a calming effect 1. During alcohol withdrawal, they help prevent dangerous symptoms like seizures and delirium tremens by compensating for the sudden decrease in GABA activity that occurs when alcohol is removed.
Key Considerations
- For anxiety treatment, typical dosing might be diazepam 5-10mg three times daily or lorazepam 1-2mg two to three times daily, while withdrawal protocols often use higher doses on a tapering schedule over 3-7 days 1.
- It's essential to note that benzodiazepines themselves carry addiction potential, so they should only be used under medical supervision, especially in patients with a history of substance abuse 1.
- Long-term use for anxiety is generally discouraged due to tolerance and dependence concerns 1.
- In patients with advanced liver disease, the use of benzodiazepines should be personalized and symptom-adapted, with a preference for short-acting drugs like lorazepam or oxazepam to avoid drug accumulation and potential encephalopathy 1.
Additional Recommendations
- Thiamine (vitamin B1) should be prescribed as part of the withdrawal process to prevent Wernicke's encephalopathy, given its low level of evidence but favorable benefit-risk balance 1.
- Regular monitoring is crucial during alcohol withdrawal to guide dosage adjustment and prevent seizures, and can be stopped after 24 hours if no specific signs appear 1.
From the FDA Drug Label
Diazepam is indicated for the management of anxiety disorders or for the short- term relief of the symptoms of anxiety. In acute alcohol withdrawal, diazepam may be useful in the symptomatic relief of acute agitation, tremor, impending or acute delirium tremens and hallucinosis The medication used for anxiety and also helps with alcohol withdrawal symptoms is diazepam 2.
- Key uses of diazepam include:
- Management of anxiety disorders
- Relief of symptoms of anxiety
- Symptomatic relief of acute alcohol withdrawal symptoms
- Relief of skeletal muscle spasm
- Adjunctive use in convulsive disorders
From the Research
Medications for Anxiety and Alcohol Withdrawal Symptoms
- Benzodiazepines are commonly used to treat anxiety and alcohol withdrawal symptoms, with diazepam and lorazepam being two of the most frequently prescribed medications 3, 4, 5, 6, 7.
- Diazepam has been shown to have a rapid onset of action and a long elimination half-life, making it a suitable option for treating moderate to severe alcohol withdrawal symptoms 3.
- Lorazepam, on the other hand, is often preferred in patients with liver disease or the elderly, as its metabolism is less affected by these factors 5.
- Both diazepam and lorazepam have been shown to be effective in treating severe alcohol withdrawal syndrome, with similar efficacy and safety profiles 7.
- However, lorazepam may be preferred due to its lower cost, although both medications can be used interchangeably based on availability 7.
- It is essential to note that benzodiazepines can cause paradoxical excitation in rare cases, and patients should be closely monitored for this adverse effect 6.