Alcohol withdrawal, in many cases, requires medical treatment and treatment center admissions due to the life threatening risks from the severe side-effects of going cold turkey. Medication is often used along side counseling support to aid the mental side of alcohol withdrawal. Here’s a rundown of common medications used by medical professionals.
Thiamine & Folic Acid
Because patients with AWS are often nutritionally depleted, thiamine (100 mg daily) and folic acid (1 mg daily) should be used routinely. Thiamine supplementation lowers the risk of Wernicke encephalopathy, which is characterized by oculomotor dysfunction, abnormal mentation, and ataxia.
Benzodiazepines and anticonvulsants
Benzodiazepines and anticonvulsants reduce psychomotor agitation and prevent progression of withdrawal symptoms, and should be administered early. There is no evidence that any one medication is superior in treating AWS, but long-acting benzodiazepines are preferred.
Benzodiazepines reduce symptoms and can prevent withdrawal seizures. They are available in long-acting (e.g., chlordiazepoxide [Librium], diazepam [Valium]) and intermediate-acting (e.g., lorazepam [Ativan], oxazepam) formulations. Long-acting benzodiazepines may more effectively prevent delirium because of the prolonged sedative and anxiolytic effects of their active metabolites. Some contend that long-acting benzodiazepines provide a smoother withdrawal experience with fewer fluctuations in symptoms; however, intermediate-acting formulations have been used successfully. In patients with hepatic dysfunction, intermediate-acting agents may be safer because they have no active metabolites.
Patients with addictive disorders prefer diazepam, alprazolam (Xanax), or lorazepam, but these medications have a greater risk of abuse. Chlordiazepoxide and oxazepam have less abuse potential, but no data support their superiority in treating AWS. Because benzodiazepines can cause respiratory depression and death when combined with alcohol, physicians should emphasize the importance of abstaining from alcohol during treatment.
Benzodiazepines can be administered using a fixed-dose or symptom-triggered schedule. A front-loading, or loading-dose, schedule is not recommended. No randomized trials have compared the varying benzodiazepine regimens. The fixed-dose schedule uses a specific dosage at specific intervals, regardless of the patient’s symptoms. Additional doses are given as needed to control symptoms, and the dosage is reduced if over-medication occurs. With a symptom-triggered schedule, medication is administered only when the patient has significant symptoms (SAWS score of 12 or more; CIWA-Ar score greater than 9). Although symptom-triggered schedules reduce medication use and shorten duration of treatment for inpatients, a trial including outpatients taking long-acting benzodiazepines found no difference between the fixed-dose and symptom-triggered schedules in total dose, patient satisfaction, or time to relapse. A symptom-triggered schedule requires the patient and caregiver to reliably rate symptoms and may not be appropriate in all cases.
Naltrexon is a drug used to decrease the desire for alcohol and opioids. Brand names commonly sold are ReVia and Vivitrol. It can be taken orally or injected and takes effects in about 30 mins. It has a longer term effect and for managed treatment vs Nalaxone, which is used for immediate emergency use.