Alcohol withdrawal symptoms

Chronic alcohol drinkers, when forced to reduce or discontinue alcohol, experience a withdrawal syndrome, which indicates the existence of physical dependence. Alcohol withdrawal symptoms classically consist of hyperexcitability in mild cases and seizures, toxic psychosis, and delirium tremens in severe ones. The dose, rate, and duration of alcohol consumption determine the intensity of the withdrawal syndrome. When consumption has been very high, merely reducing the rate of consumption may lead to signs of withdrawal. 

Significant progress has been made in establishing safe and effective medications for alcohol withdrawal. Pharmacotherapy with a benzodiazepine is the treatment of choice for the prevention and treatment of the signs and symptoms of alcohol withdrawal. Many patients detoxify from alcohol without specific treatment or medications. However, it is difficult to determine accurately which patients require medication for alcohol withdrawal. Patients in good physical condition with uncomplicated, mild to moderate alcohol withdrawal symptoms usually can be treated as outpatients. 

Preliminary studies suggest that GHB-based drugs may also be useful in treating Alzheimer s disease or Parkinson s disease, but it is still too early to tell. Two European studies found GHB effective in relieving alcohol craving and alcohol withdrawal symptoms. In one study, alcoholics took a moderated daily dose for three months. Participants reduced their drinking by half, and their days of abstinence tripled. Another study found that GHB relieved opiate withdrawal symptoms. 

Long-acting benzodiazepines (e.g. diazepam and chlordiazepoxide) are used to attenuate alcohol withdrawal symptoms but they also have a dependence potential. To minimise the risk of dependence, administration should be for a limited period only (e.g. chlordiazepoxide 20 mg 4 times daily, gradually reducing to zero over 7-14 days). Mild alcohol withdrawal symptoms may be treated with a lower starting dose, such as 15 mg four times a day. In all cases, the patient should be counselled about the proposed length of the treatment course. Benzodiazepines should not be prescribed if the patient is likely to continue drinking alcohol. 

A multicenter clinical study was conducted with GHB in the treatment of 179 patients who were experiencing alcohol withdrawal symptoms.46 Serious side effects remained low to moderate during the study and the drug was well tolerated. During the study period, 78% of the treated patients attained complete abstinence. Thirty patients remained abstinent one year later. The only side effect reported was occasional and transient dizziness. Researchers have surmised that GHB may be effective in the suppression of withdrawal symptoms in alcoholics. 

Tolerance may occur to the point that patients can appear to be alert and talking coherently with blood alcohol levels in excess of 400 mg/dl, but these individuals are still at risk of respiratory arrest and death at that level of intoxication. Later, they will not remember what occurred during this time (they are in a blackout), and they may experience alcohol withdrawal symptoms when their BAL drops from 400 to 200, a level that is still indicative of intoxication for most people. 

Carbamazepine (16) at plasma levels of 4—10 pg/ml exerted a remarkable drop in seizure frequency,60 showed no tolerance after six days at 50 mg/kg daily,61 was equivalent to diphenyl-hydantoin62 and primidone63 (17) in preventing psychomoter seizures and improved alcohol withdrawal symptoms in male outpatients.64 Eterobarb (18) is a safe and potent anticonvulsant with a low hypnotic effect.65... 

Another B complex vitamin effected is Be (pyridoxine). This vitamin is required for transaminations ana decarboxylations, two processes of major importance in the metabolism of the central nervous tissue. B0 dehciency occurs in many bodily disorders, dermatitis, anemia, and epileptic seizures, to name some. In alcoholics it is most often seen in delirium tremens (an alcohol withdrawal symptom). 

Diazepam (brand name Valium) A benzodiazepine used to treat anxiety, which may act as a sedative. It provides short-term relief for mild to moderate anxiety and is used to treat epilepsy and alcohol withdrawal symptoms. 

Clorazepate is a benzodiazepine that potentiates action of GABA, an inhibitory neurotransmitter, resulting in increased neuronal inhibition and CNS depression, especially in limbic system and reticnlar formation. Clorazepate is indicated in the management of anxiety disorders relief of acnte alcohol withdrawal symptoms and adjunctive therapy in management of partial seizures. 

Gabapentin 800 mg on the first day and 600 mg/day on the next 2 days has been prospectively studied in the treatment of acute severe alcohol withdrawal symptoms in 37 patients, of whom 27 were early responders and 10 required treatment with clomethiazole ( = 4) or clonazepam... 

Comparative studies In 40 in-patients with alcohol dependence disorder, who took zonisamide or diazepam for detoxification in a 3-week, randomized, flexible-dose trial [370 J, zonisamide was started at a dose of 400-600 mg/day (week 1) and tapered to a minimum dose of 100-300 mg/day (week 3). Diazepam was administered using a similar regimen (from 30-50 to 5-15 mg/day). Both drugs reduced alcohol withdrawal symptoms, but the effect was more marked with zonisamide. Those randomized to zonisamide had less anxiety and less daytime sedation than those who took diazepam. 

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