From the Guidelines
For a patient admitted with alcohol withdrawal requesting anxiety medication and acid reflux treatment, I recommend a benzodiazepine such as diazepam (Valium) 5-10mg orally every 6 hours as needed for anxiety and withdrawal symptoms, with dosing based on symptom severity using a validated assessment tool like the CIWA-Ar scale, as supported by the most recent guidelines 1.
Key Considerations
- The patient's anxiety and withdrawal symptoms can be effectively managed with benzodiazepines, which are considered the 'gold standard' treatment for alcohol withdrawal syndrome (AWS) 1.
- For acid reflux, which is common during withdrawal due to increased gastric acid production and irritation from prior alcohol use, proton pump inhibitors like pantoprazole or H2 blockers like famotidine effectively reduce acid production 1.
- The benzodiazepine will help prevent serious withdrawal complications like seizures or delirium tremens while managing anxiety symptoms.
- The dose should be tapered as the patient stabilizes.
- Additionally, ensure the patient receives thiamine supplementation (100mg IV/IM for 3-5 days), folate, and multivitamins to address common nutritional deficiencies in alcohol use disorder, as recommended by recent guidelines 1.
Monitoring and Adjustments
- Regular monitoring of vital signs and withdrawal symptoms is essential for appropriate medication adjustments.
- The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale is a useful tool for evaluating the severity of AWS and guiding treatment decisions 1.
- Patients with severe AWS, advanced age, or significant comorbidities may require closer monitoring and adjustments to their treatment regimen 1.
From the FDA Drug Label
1.4 Treatment of Symptomatic Gastroesophageal Reflux Disease (GERD) Omeprazole delayed-release capsules are indicated for the treatment of heartburn and other symptoms associated with GERD for up to 4 weeks in patients 2 years of age and older.
2.1 Recommended Adult Dosage Regimen by Indication Table 1 shows the recommended dosage of omeprazole in adult patients by indication Indication Dosage of Omeprazole Treatment of Symptomatic GERD 20 mg once daily Up to 4 weeks
The patient can be given 20 mg of omeprazole once daily for up to 4 weeks to treat symptoms of acid reflux, such as heartburn, associated with GERD 2.
- Key considerations:
- The patient should take omeprazole delayed-release capsules before meals.
- Antacids may be used concomitantly with omeprazole delayed-release capsules.
- Missed doses should be administered as soon as possible, but not two doses at one time. However, the request for anxiety medication cannot be addressed based on the provided drug labels, as they only pertain to omeprazole.
From the Research
Anxiety Medication for ETOH Withdrawal
- Benzodiazepines are commonly used to treat anxiety and withdrawal symptoms in patients with ETOH withdrawal 3, 4, 5, 6
- Lorazepam and diazepam are two benzodiazepines that are often used for this purpose, with lorazepam being an excellent first choice due to its intermediate half-life and high bioavailability 3
- Diazepam has also been shown to be effective in treating moderate to severe alcohol withdrawal, with a shorter time to peak effect and a longer elimination half-life compared to other benzodiazepines 4
- A study comparing lorazepam and diazepam found that both medications had similar admission rates and ED return visit rates, with no significant differences in outcomes 5
Acid Reflux Treatment
- There is limited research on the treatment of acid reflux in patients with ETOH withdrawal
- However, a study on calcium carbonate found that it attenuated withdrawal symptoms and reduced craving in alcohol-dependent patients, which may be relevant for patients with acid reflux symptoms 7
- Calcium carbonate may be a potential treatment option for acid reflux in patients with ETOH withdrawal, but further research is needed to confirm its effectiveness
Combination Therapy
- Combination therapy with benzodiazepines and other medications, such as clonidine and beta-adrenergic blocking agents, may be effective in treating ETOH withdrawal symptoms 3
- However, the optimal combination and dosage of medications for ETOH withdrawal and acid reflux treatment is not well established and requires further research