Alcohol withdrawal syndrome treatment

An important initial intervention for a minority of alcohol-dependent patients is the management of alcohol withdrawal through detoxification. The objectives in treating alcohol withdrawal are relief of discomfort, prevention or treatment of complications, and preparation for rehabilitation. Successful management of the alcohol withdrawal syndrome is generally necessary for subsequent efforts at rehabilitation to be successful treatment of withdrawal alone is usually not sufficient, because relapse occurs commonly. 

There are four different alcohol withdrawal syndromes, which differ in terms of their pharmacologic treatment and need for hospitalization. 

DRUGS FOR THE TREATMENT OF ACUTE ALCOHOL WITHDRAWAL SYNDROME... 

Drugs for the Treatment of Acute Alcohol Withdrawal Syndrome Diazepam (generic, Valium, others)... 

Patients with mild symptoms of alcohol withdrawal do not generally require medication therapy. Benzodiazepines, like diazepam or alprazolam, are the treatment of choice for patients with severe alcohol withdrawal syndromes like delirium tremens. Barbiturates can also be used for this disorder, but are often less prescribed because they are not as safe as benzodiazepines. Both barbiturates and benzodiazepines are effective in treating the anxiety, tremor, insomnia, and hand tremors associated with delirium tremens. 

S. D. Ferrara, F. Fadda, and G. L. Gessa. Gamma-hydroxybutyric Acid for Treatment of Alcohol Withdrawal Syndrome. Lancet2 (8666) (1989) 787-789 Beghe, F., and M. T. Carpanini. Safety and Tolerability of Gamma-hydroxybutyric Acid in the Treatment of Alcohol-dependant Patients. Alcohol 20... 

F. Fadda, and G. L. Gessa. Gamma-hydroxybutyric Acid for Treatment of Alcohol Withdrawal Syndrome. Lancet 2 (8666) (1989) 787-789. 

Outline the pharmacotherapy of (a) the alcohol withdrawal syndrome and (b) alcoholism. Describe the toxicity and treatment of acute poisoning with (a) methanol and (b) ethylene glycol... 

Systematic reviews A systematic review has been conducted to evaluate the efficacy and safety of carbamazepine and oxcarbazepine in treatment of alcohol withdrawal syndrome [108 ]. The authors concluded that trials have provided inconclusive evidence of the efficacy of carbamazepine in preventing alcohol withdrawal seizures and delirium tremens in comparison with benzodiazepines, which remain the primary treatment of moderate-to-severe alcohol withdrawal syndrome. Adverse reactions were not a major problem. 

Schmidt F, Kienast T, Preuss UW, Plenge T, Heinz A, Schaefer M. Levetiracetam for the treatment of alcohol withdrawal syndrome a multicenter,... 

Rubio G, Lopez-Munoz F, Ponce G, Pascual JM, Martfnez-Gras I, Ferre F, Jim6nez-Arriero mA, Alamo C. Zonisamide versus diazepam in the treatment of alcohol withdrawal syndrome. Pharmacopsychiatry 2010 43(7) 257-62. 

The fact that P(3HB-co-4HB) and P(4HB) are also polymers with potential therapeutic applications has been pointed out in a review [6]. The 4HB units are pharmacologically active compounds, which have been used in the treatment of alcohol withdrawal syndrome [239,240] and narcolepsy [241]. Other potential applications include the treatment of patients with chronic schizophrenia, catatonic schizophrenia, atypical psychoses, chronic brain syndrome, neurosis, drug addiction and withdrawal, Parkinson s disease and other neuropharmacological illnesses, hypertension, ischaemia, circulatory collapse, radiation exposure, cancer and myocardial infarction [242]. 

Gossop M (1988) Clonidine and the treatment of the opiate withdrawal syndrome. Drug Alcohol Depend 21 253-259... 

A 33-year-old woman has a 15-year history of alcohol abuse. She comes to the emergency department for treatment of injuries received in a fall. She says she has been drinking heavily and almost continuously for 2 weeks, and she wants to stop. Which of the following drugs would most effectively and safely lessen the intensity of her withdrawal syndrome ... 

The immediate concern in the treatment of alcoholics is detoxification and management of the ethanol withdrawal syndrome. Once the patient is detoxified, longterm treatment requires complete abstinence, psychiatric treatment, family involvement, and frequently support from lay organizations such as Alcoholics Anonymous. 

Unlabeled Uses Acute alcohol withdrawal, arrhythmia (especially supraventricular and ventricular tachycardia), improved survival in diabetics with heart disease, mild to moderately severe CHF (adjunct) prevention of migraine, thyrotoxicosis, tremors treatment of hypertrophic cardiomyopathy, pheochromocytoma, and syndrome of mitral valve prolapse... 

The strongest traditions of inpatient detoxification relate mainly to alcohol misuse, in which the withdrawal syndrome is inherently more dangerous than that from opiates, and the avoidance of withdrawal complications in standard treatment may be the prime consideration in selecting admission. (In drug misuse, as we shall see in subsequent chapters, indications for admission increasingly relate to new developments, such as rapid... 

The treatment of alcohol withdrawal incorporates general supportive measures, as well as management of specific symptoms. Supportive measures include abstinence from alcohol, ample rest, adequate general nutrition, and reality orientation. It is important to treat the syndrome vigorously and, when appropriate, to prevent it by using sufficient doses of medication. 

Anxiety is a common complaint that invariably complicates addictive illnesses. Estimates of co-morbid anxiety and alcohol disorders range from 20% to 50%, with men more likely to self-medicate anxiety than women (453, 454 and 455). Some investigators have also found increased rates of alcoholism in family members of patients with anxiety disorders (456, 457). Patients with alcohol or drug dependence show a tendency for development of panic disorder earlier, and it has been suggested that repeated alcohol withdrawal may be the trigger for panic attacks in susceptible individuals ( 458, 459). Finally, BZDs, the primary pharmacological treatment for these disorders, are themselves addictive and sometimes associated with anxiety syndromes, especially on their discontinuation ( 460). 

Naltrexone is generally taken once a day in an oral dose of 50 mg for treatment of alcoholism. An extended-release formulation administered as an IM injection once every 4 weeks is also effective. The drug can cause dose-dependent hepatotoxicity and should be used with caution in patients with evidence of mild abnormalities in serum aminotransferase activity. The combination of naltrexone plus disulfiram should be avoided, since both drugs are potential hepatotoxins. Administration of naltrexone to patients who are physically dependent on opioids precipitates an acute withdrawal syndrome, so patients must be opioid-free before initiating naltrexone therapy. Naltrexone also blocks the therapeutic effects of usual doses of opioids. 

Physical dependence on benzodiazepines is recognized as a major problem, and occurs after relatively short periods of treatment (50,51), particularly in patients with a history of benzodiazepine or alcohol problems. Abrupt withdrawal can cause severe anxiety, perceptual changes, convulsions, or delirium. It can masquerade as a return of the original symptoms in a more severe form (rebound), or present with additional features (SEDA-17,42 11). Up to 90% of regular benzodiazepine users have adverse symptoms on withdrawal. The differences between rebound, withdrawal syndrome, and recurrence have been reviewed in detail (3). 

Carbamazepine is used in the treatment of epilepsy and trigeminal neuralgia. Unlabeled uses include treatment of postherpetic pain syndrome, neurogenic diabetes insipidus, bipolar disorder, alcohol withdrawal, and cocaine dependence. 

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