From the Guidelines
Diazepam should be used for alcohol withdrawal at a dose of 5-10 mg every 6-8 hours, as recommended by the most recent guidelines. This dose can be adjusted based on the severity of symptoms and the patient's response to treatment. The use of diazepam for alcohol withdrawal is supported by its efficacy in reducing withdrawal symptoms and the risk of seizures and delirium tremens, as well as its long half-life and active metabolites, which provide smooth coverage and help prevent breakthrough symptoms 1.
Key Considerations
- A symptom-triggered approach using the CIWA-Ar scale is often preferred, where diazepam is given when withdrawal symptoms reach a certain threshold 1.
- Patients should be monitored for respiratory depression, especially if they have liver disease, which may slow diazepam metabolism.
- Thiamine, folate, and multivitamins should be administered concurrently to prevent Wernicke's encephalopathy and address nutritional deficiencies common in alcohol use disorder.
- The dose of diazepam may need to be adjusted in patients with hepatic dysfunction, and alternative medications such as lorazepam or oxazepam may be considered in these cases 1.
Treatment Approach
- The treatment approach should be individualized based on the patient's severity of symptoms, medical history, and response to treatment.
- A fixed-dose regimen may not be suitable for all patients, and a symptom-triggered approach may be more effective in preventing the accumulation of the drug and reducing the risk of adverse effects 1.
- The use of benzodiazepines, including diazepam, should be limited to the initial 10-14 days of treatment, and alternative medications should be considered for long-term management of alcohol use disorder 1.
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 The recommended dose of diazepam for alcohol withdrawal is:
- 10 mg, 3 or 4 times during the first 24 hours
- Then reduce to 5 mg, 3 or 4 times daily as needed 2
From the Research
Diazepam Dose for Alcohol Withdrawal
- The dose of diazepam for alcohol withdrawal can vary, but studies suggest that a loading dose of 20 mg can be effective in managing symptoms 3, 4, 5.
- In one study, patients received 20 mg of diazepam every 2 hours until they were asymptomatic, with a median number of doses being three, given over a period of 7.6 hours 3.
- Another study found that 75.7% of patients completed detoxification with supportive therapy only, while 24% required pharmacotherapy, with 40.5% of those requiring only one 20-mg dose of diazepam 4.
- A retrospective cohort study found that the median cumulative oral diazepam dose was 20 mg, while 15% of patients received a cumulative dose of 100 mg or more 5.
- The use of diazepam in alcohol withdrawal has been shown to be safe and effective, with a low incidence of complications, even in patients with liver disease and elderly patients 6.
Factors Influencing Diazepam Dose
- The severity of alcohol withdrawal symptoms can influence the dose of diazepam required, with more severe symptoms requiring higher doses 3, 4.
- The use of a symptom-triggered therapy approach, where diazepam is administered only when symptoms are present, can help to reduce the overall dose required 5.
- Patient demographics, such as age and medical history, can also influence the dose of diazepam required, with older patients and those with liver disease potentially requiring lower doses 6.
Comparison with Other Treatments
- Diazepam has been compared to other benzodiazepines, such as lorazepam and chlordiazepoxide, and has been found to have a similar efficacy and safety profile 6.
- Phenobarbital, a long-acting barbiturate, has also been compared to benzodiazepines, including diazepam, and has been found to be a potentially effective alternative for managing alcohol withdrawal symptoms 7.