====== Alcohol withdrawal syndrome treatment ======

Mild EtOH withdrawal is managed with a quiet, supportive environment, reorientation and one-
to-one contact. If symptoms progress, institute pharmacologic treatment.

===== Benzodiazepines =====

see [[Benzodiazepine for alcohol withdrawal syndrome]].

===== Adjunctive medications =====

Associated conditions commonly seen in patients experiencing alcohol withdrawal syndrome include dehydration, fluid and electrolyte disturbances, infection, pancreatitis, and alcoholic ketoaci- dosis, and should be treated accordingly.

Other medications used for EtOH withdrawal itself include:

1. drugs useful for controlling HTN (caution: these agents should not be used alone because they do
not prevent progression to more severe levels of withdrawal, and they may mask symptoms of withdrawal)

a) β-blockers: also treat most associated tachyarrhythmias

● atenolol (Tenormin®): reduces length of withdrawal and BDZ requirement

● ✖ avoid propranolol (psychotoxic reactions) b) α-agonists:donotusetogetherwithβ-blockers

2. phenobarbital: an alternative to BDZs. Long-acting, and helps prophylaxis against seizures

3. baclofen: a small study
((Addolorato G, Caputo F, Capristo E, et al. Rapid suppression of alcohol withdrawal syndrome by baclofen. Am J Med. 2002; 112:226–229))

found 10 mg PO q d X 30 days resulted in a rapid reduction of symptoms after the initial dose and continued abstinence

4. “supportive” medications

a) thiamine:100 mg IM QD ×3 d(can be given IV if needed, but there is a risk of adverse reaction). Rationale: high-concentration glucose may precipitate acute Wernicke’s encephalopathy in patients with thiamine deficiency

b) folate1mgIM,IVorPOqd×3d

c) MgSO4 1 gm × 1 on admission: helpful only if magnesium levels are low, reduces seizure risk.

Be sure renal function is normal before administering

d) vitamin B12 for macrocyticanemia: 100 mcgIM(do not give before folate)

e) multivitamins:of benefit only if the patient is malnourished

5. seizures: 

a) [[phenytoin]] (Dilantin®): load with 18 mg/kg = 1200 mg/70 kg

b) continued seizures may sometimes be effectively treated with paraldehyde if available

6. ethanol drip: not widely used. 5% EtOH in D5 W, start at 20 cc/hr and titrate to a blood level of 100–150 mg/dl


===== References =====