Managing alcohol withdrawal syndrome. Diazepam/ oxazepam OK but other classes should be avoided

Goodfellow Gems Logo

Goodfellow Gems

"Managing alcohol withdrawal syndrome. Diazepam/ oxazepam OK but other classes should be avoided"

Managing alcohol withdrawal syndrome should be supervised either as an in-patient or an outpatient. The medications of choice are diazepam 5 mg to 20 mg 2 to 4 hourly or oxazepam  15 to 30 mg 3 to 4 times daily with lower doses in the elderly.  Adjusting the dose based on clinical status may be preferable to a fixed dose as it can reduce total dose. Oxazepam is the first choice where there is cirrhosis as it has no active metabolites.

Practices and drugs to avoid: Intensive hydration, gradual withdrawal of alcohol, anticonvulsants other than benzodiazepines, neuroleptics, beta-blockers and clonidine, magnesium, vitamin B6 and nicotinic acid. Medications used to maintain abstinence (acamprosate, baclofen, disulfiram and naltrexone )  should only be started when  withdrawal has been completed.

This GEM has been viewed and approved by Professor Brian McAvoy of the Tasmanian Department of Health and Human Services, Alcohol and Drug Services.

References:

  1. Preventing alcohol withdrawal syndrome. Prescribe International December 2015;24(166):300-1.

Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.


As published in NZ Doctor 16/03/2016