Alcohol Withdrawal Treatment

The clinical approach to treat AWS is to control the clinical manifestations of alcohol withdrawal, avoid major medical consequences from developing, and link patients to rehabilitation for long-term recovery. Patients with minor symptoms of alcohol withdrawal may just require supportive care, whereas those with moderate-to-severe complaints may require therapeutic intervention.

Nutritional Assistance

Nutritional support, when appropriate, should be administered to patients with AWS due to the possibility of nutritional deficits. Folic acid and thiamine should be given on a regular basis as part of such support. A daily dose of 1 milligram of folic acid is suggested. Wernicke’s encephalopathy can be prevented by thiamine replacement, which should be given to all individuals at a dose of 100 milligrams per day. In Wernicke’s encephalopathy, high-potency vitamins containing 500 milligrams of thiamine should be administered Intravenously 3 times daily for 3 days.

Because serum magnesium concentrations have been demonstrated to be low in alcohol withdrawal, magnesium supplements have also been advocated. Magnesium levels, on the other hand, appear to be returning to normal as the AWS winds down. Due to this restoration of magnesium back to normal levels, magnesium supplementation has also been shown to be ineffective in some studies in the treatment of AWS.

Medications

Benzodiazepines. In individuals with AWS, benzodiazepines are favored and regarded as first-line medication. These medications help to avoid symptom development by reducing symptoms of withdrawal such as seizures. AWS is treated with benzodiazepines that have a long or intermediate duration of action. Chlordiazepoxide (half-life of active metabolites: 14 to 100 hours) and diazepam (30 to 100 hours) are examples of long-acting agents. Lorazepam (12-hour half-life), oxazepam (5 to 15 hours), and alprazolam (6 to 26 hours) are examples of intermediate-acting medications. There isn’t enough evidence to suggest that one medicine is better than the others for managing AWS. Long-acting benzodiazepines, on the other hand, are thought to have a gentler withdrawal impact than intermediate-acting benzodiazepines. Intermediate-acting medicines, which do not have active ingredients/forms, may be preferable for individuals with impaired hepatic function, such as the elderly. Furthermore, drowsiness and respiratory impairment are less likely with these medicines. Tailored dosages are needed to treat clinical symptoms, and in the event of refractory alcohol withdrawal, very high quantities may be required, albeit respiratory distress is a risk.

A symptom-triggered dosage schedule and fixed-dose schedule are the two most commonly utilized benzodiazepine administration regimes for AWS.  The fixed-dose regimen uses preset doses at periodic intervals, but it also provides for extra doses as required to control symptoms. Benzodiazepines are used in the symptom-triggered regimen only when the individual has substantial symptoms, as measured by a CIWA-Ar score of >9. The symptom-triggered regimen has been found in studies to decrease drug use and duration of treatment.

The average duration of treatment and dosage of oxazepam were 20 hrs vs. 62.7 hrs and 37.5 milligrams vs. 231.4 milligrams, respectively, in research by Daeppen et al contrasting symptom-triggered dosing to fixed-schedule dosing utilizing oxazepam to manage alcohol withdrawal, with no variation in patient comfortability. Only inpatient treatment of alcohol withdrawal was the focus of this research.

Other Drug Treatments.  Although there is nothing in the form of controlled trials data to back up their usage, neuroleptic medications such as haloperidol and phenothiazines may help patients with uncontrollable agitation. Furthermore, they are not as helpful in preventing seizures and delirium as benzodiazepines.

Anticonvulsants like oxcarbazepine, Divalproex, and carbamazepine may be beneficial in the treatment of alcoholism by lowering alcohol cravings and in the therapy of AWS due to their anti-kindling action, according to some evidence. Surprisingly, neither Delirium Tremens nor seizures were prevented by these medications. Gabapentin proved to be more effective than lorazepam in treating AWS in one trial. Furthermore, it appears to lessen alcohol cravings during abstinence. More randomized studies are needed, like with the other antiepileptic drugs.

In individuals with refractory Delirium Tremens, propofol and barbiturates have been recommended. Despite the fact that barbiturates are affordable, there has been little controlled research. Furthermore, when taken with alcohol, they raise the risk of respiratory distress. The usage of propofol is poorly documented. Its exorbitant cost, however, is a significant disadvantage. Baclofen, a skeletal muscle relaxant and structural counterpart of GABA, was studied as a therapy for AWS. Baclofen was found to be equally beneficial as diazepam in treating AWS, suggesting that it could be used as a therapeutic option.

Non-benzodiazepines’ success in the management of AWS and AUD, on the other hand, need more regulated clinical research. Benzodiazepines will continue to be the therapeutic option of choice until sufficient evidence is available to justify the use of alternative medicines over them.

Adjunctive therapy is a type of treatment that is used in conjunction with another treatment Based on the patient’s symptoms, adjunctive therapy may be needed in addition to benzodiazepine medication. Alpha-adrenergic agonist clonidine and Beta-blockers may be used to alleviate adrenergic symptoms such as heart rate or blood pressure reduction, as well as tremor reduction. Delirium and seizures are not prevented by them. Any of the previously mentioned agents could be used as a treatment option. The choice of agent is made based on the individual clinical symptoms being addressed. These supplementary agents should not be used alone to treat AWS.

Monitoring

The periodicity of screening and monitoring is determined by the intensity of the patient’s symptoms. Hospital patients may be watched and checked several times a day at first until they start to feel better. Once the patient has been stabilized, he or she should be checked on a daily basis until the symptoms have subsided and the medicine dosage has been reduced. Patients may need to be directed to a long-term intensive outpatient program, a medical professional who is a specialist in addiction, or an inpatient treatment facility after completing therapy.