Specific Medical Treatment for Alcohol Withdrawal Symptoms

Treatment Depends on the Severity of Symptoms

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When you stop drinking, you may experience alcohol withdrawal symptoms. You can seek medical treatment that can relieve these. Your healthcare provider will use medications to calm you as you go through withdrawal.

Alcohol Withdrawal Symptoms

Mild to moderate withdrawal symptoms are the most common when you stop drinking alcohol. You may be agitated, experience trembling, have no appetite, and have trouble sleeping.

With moderate withdrawal symptoms, seizures or hallucinations occur 15 to 20 percent of the time without progressing to full-blown delirium tremens. With mild and moderate symptoms, you may be treated on an outpatient basis, while if you have delirium tremens, inpatient treatment is needed.

Outpatient Treatment for Mild to Moderate Withdrawal Symptoms

The therapy will be based on the symptoms you are experiencing. A four-day course of anti-anxiety medication is typical for mild to moderate withdrawal symptoms. You'll be scheduled for follow-up and rehabilitation treatment. It's important that you return to the emergency room if your withdrawal symptoms become severe. While going through these first days of withdrawal, it is best to be looked after by a friend or family member for safety.

Benzodiazepines: Patients are usually given one of the benzodiazepine anti-anxiety drugs, such as Valium (diazepam),  Ativan (lorazepam), Librium (chlordiazepoxide), and Serax (oxazepam).

They work on nerve cells in the brain to prevent delirium tremens and the risk of seizures, which are two serious withdrawal symptoms. The long-acting benzodiazepines with active metabolites (diazepam or chlordiazepoxide) are preferred for most patients. But if you have liver damage, lorazepam or   oxazepam will be given because they have don't have active metabolites.

Common side effects of benzodiazepines include daytime drowsiness. They can make respiratory problems worse. They can interact with other medications and are very dangerous when they are used in combination with alcohol, which is a concern in a person who might resume drinking. Side effects may be worse in older people. They can cause birth defects, so they should not be used by pregnant women or while breastfeeding. Benzodiazepines lose effectiveness over time and patients can become dependent on them. If you take them for four weeks, you might experience withdrawal symptoms from them.

Other Drugs for Mild to Moderate Withdrawal

The following agents may also be given, depending on the symptoms and their severity.

Beta-blockers. Beta blockers, such as propranolol (Inderal) and atenolol (Tenormin), slow the heart rate and reduce tremor. They are sometimes used in combination with benzodiazepines.

Anti-Seizure Medications. Anti-seizure agents, such as carbamazepine (Tegretol) or divalproex sodium (Depakote) may be used so less benzodiazepine is needed.

Specific Treatment for Severe Symptoms

Treating Delirium Tremens: These are very dangerous and must be treated immediately to prevent fatalities, which can reach 20 percent if untreated.

Symptomatic patients are usually given intravenous anti-anxiety medications. Lidocaine (Xylocaine) may be given to people with disturbed heart rhythms. Treatment with fluids is important and restraints may be needed.

Treating Seizures. Seizures are usually self-limited and treated with a benzodiazepine. Intravenous phenytoin (Dilantin) may be given in addition if the person undergoing withdrawal has a history of epilepsy or seizures or if the seizures are uncontrolled.

Psychosis. Haldol (haloperidol) might be given if the person undergoing withdrawal is having hallucinations or they are showing violent behavior.

One form of psychosis seen in people undergoing alcohol withdrawal is Korsakoff's psychosis, caused by vitamin B1 deficiency, and injections of the vitamin might be given to treat it.may be administered.

Seeking Help for Withdrawal

It's wise to get medical support for your withdrawal symptoms. While it can be difficult to be open with your health care provider, it is essential to prevent more severe symptoms and to give you a better chance of succeeding in quitting alcohol.

Source:

Hoffman, RS, et. al. Management of moderate and severe alcohol withdrawal syndromes. UpToDate. Jan. 17, 2017. https://www.uptodate.com/contents/management-of-moderate-and-severe-alcohol-withdrawal-syndromes. 

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