From the Guidelines
Benzodiazepines are the primary treatment option for Alcohol Withdrawal Syndrome (AWS).
Treatment Options for AWS
The following are the treatment options for AWS:
- Benzodiazepines: considered the 'gold standard' treatment for AWS, given their efficacy for reducing both withdrawal symptoms and the risk of seizures and/or delirium tremens 1.
- Long-acting benzodiazepines: (e.g. diazepam, chlordiazepoxide) provide more protection against seizures and delirium, but short and intermediate-acting benzodiazepines (e.g. lorazepam, oxazepam) are safer in elderly patients and those with hepatic dysfunction 1.
- Clomethiazole: also used to treat AWS in Europe, but carries a potential risk of abuse 1.
- Thiamine: should be given to all patients with AWS (100-300 mg/day) to prevent diminished cognitive function due to thiamine deficiency 1.
- Other medications: such as baclofen, sodium oxybate, topiramate, and acamprosate may be used in certain cases, but their use is limited and more studies are required to obtain evidence of their efficacy and safety in patients with ALD 1.
Important Considerations
- Severity scores: such as the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) can be useful in evaluating the severity of AWS and guiding treatment 1.
- Inpatient vs outpatient treatment: inpatient treatment is recommended for patients with serious complications of AWS, while outpatient treatment may be more cost-effective for those with mild to moderate symptoms 1.
- Pharmacological treatment: should be tailored to the individual patient's needs and medical history, and should be used in conjunction with supportive care and counseling 1.
From the Research
Treatment Options for Alcohol Withdrawal Syndrome (AWS)
The treatment options for AWS can be categorized into pharmacological and supportive therapies.
- Pharmacological Therapies:
- Benzodiazepines are the primary treatment for AWS, particularly for moderate to severe symptoms 2, 3, 4, 5, 6.
- Non-benzodiazepine GABAergic medications, such as carbamazepine, gabapentin, and valproic acid, have shown promise in treating AWS, especially for patients with mild to moderate symptoms 2, 3, 4, 5, 6.
- Other medications, including α2-agonists (clonidine and dexmetedomidine), β-blockers, and neuroleptic agents, can be used as adjunctive treatments to control neuroautonomic hyperactivity and hallucinations 4.
- Supportive Therapies:
- Supportive care, including monitoring and daily assessment, is essential for patients with AWS, particularly those being treated as outpatients 3, 5.
- Patients with severe symptoms or those at high risk of complications should receive inpatient treatment 3.
- Long-term success depends on facilitating the patient's entry into ongoing treatment for alcohol use disorder 3, 5.
Patient Assessment and Monitoring
Patients with AWS should be assessed using tools such as the Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised, and the Short Alcohol Withdrawal Scale 5.
- Patients with mild to moderate withdrawal symptoms without additional risk factors for developing severe or complicated withdrawal can be treated as outpatients 5.
- Physicians should monitor outpatients with AWS daily for up to five days after their last drink to verify symptom improvement and to evaluate the need for additional treatment 5.