Ethanol withdrawal

Chronic administration of ethanol may up-regulate L-type and N-type VGCCs—an effect that may contribute to ethanol withdrawal symptoms (Kahkonen and Bondarenko 2004 McMahon et al. 2000), probably through involvement of NMDA receptors and other neural circuitry (Calton et al. 1999). 

Fadda F, Columbo G, Mosca E, et al Suppression by gamma-hydroxybutyric acid of ethanol withdrawal syndrome in rats. Alcohol Alcohol 24 447-451, 1989 Fine J, Finestone SC. Sensory disturbances following ketamine anesthesia recurrent hallucinations. Anesth Analg 52 428 30, 1973 Freese TE, Miotto K, Reback CJ The effects and consequences of selected club drugs. J Subst Abuse Treat 23 151—156, 2002... 

Wilson, J, Watson, WP and Little, HJ (1998) CCK(B) antagonists protect against anxiety-related behaviour produce by ethanol withdrawal, measured using the elevated plus-maze. Psychopharmacology 137 121-131. 

Merlo Pich E, Lorang M, Yeganeh M, Rodriguez de Eonseca E, Raber J, et al. 1995. Increase of extracellular corticotropinreleasing factor-like immunoreactivity levels in the amygdala of awake rats during restraint stress and ethanol withdrawal as measured by microdialysis. J Neurosci 15(8) 5439-5447. 

Olive ME, Koenig HN, Nannini MA, Hodge GW. 2002. Elevated extraceUular erf levels in the bed nucleus of the stria terminalis during ethanol withdrawal and reduction by subsequent ethanol intake. Pharmacol Biochem Behav 72 (1-2) 213-220. 

Rassnick S, Heinrichs SC, Britton KT, Koob GF. 1993. Microinjection of a corticotropin-releasing factor antagonist into the central nucleus of the amygdala reverses anxiogenic-like effects of ethanol withdrawal. Brain Res 605(1) 25-32. 

In contrast, some animal studies have suggested that female rats have an increased sensitivity to nicotine althongh these have assessed acnte antinociceptive effects and decreases in motor activity (e.g. Cronan et al. 1985 Craft and Milholland 1998) or chronic increases in locomotion (Kanyt et al. 1999). However, female mice of three strains were reported to be less sensitive than males to motor depressant effects of nicotine (Hatchell and Collins 1977). Gonadal hormones have been suggested to play a part in stimulus control as responses to nicotine during ethanol withdrawal were lower in intact females compared with ovariectomised females and males (Jung et al. 2000). 

Jessup M (1996) Nicotine a gateway dmg J Am Med Womens Assoc 51 21 Jung ME, Wallis CJ, Gatch MB, Lai H (2000) Sex differences in nicotine substitution to a pentylenetetrazol discriminative stimulus during ethanol withdrawal in rats. Psychopharmacology 149 235-240... 

Alcoholism is among the major health problems in most countries. Dependence on ethanol, as with other addictive drugs, is expressed as drug-seeking behavior and is associated with a withdrawal syndrome that occurs after abrupt cessation of drinking. The ethanol withdrawal syndrome is characterized by tremors, seizures, hyperthermia, hallucinations, and autonomic hyperactivity. 

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. 

Schulteis, G., Markou, A., Cole, M., and Koob, G.E (1995) Decreased brain reward produced by ethanol withdrawal. Proc Natl Acad Sci USA 92 5880-5884. 

Diazepam BDZ receptor agonist that facilitates GABA-mediated activation of GABA A receptors Prevention and treatment of acute ethanol withdrawal syndrome ... 

Treatment of ethanol withdrawal is supportive and relies on benzodiazepines, taking care to use compounds such as oxazepam and lorazepam, which are not as dependent on hepatic metabolism as most other benzodiazepines. In patients in whom monitoring is not reliable and liver function is adequate, a longer-acting benzodiazepine such as chlordiazepoxide is preferred. 

Diana M, Pistis M, Carboni S, Gessa GL, Rossetti ZL (1993) Profound decrement of mesolimbic dopaminergic neuronal activity during ethanol withdrawal syndrome in rats elctrophysiological and biochemical evidence. Proc Natl Acad Sci USA, 90 7966-7969. 

Fadda, F., G. Colombo, E. Mosca, and G. L. Gessa. Suppression by Gamma-hydroxybutyric Acid of Ethanol Withdrawal Syndrome in Rats. Alcohol... 

Tiapride appears to be useful in alcohol withdrawal as an alternative to the benzodiazepines (2). It facilitates the management of ethanol withdrawal, but its use in patients at risk of severe reactions in acute withdrawal should be accompanied by adjunctive therapy for hallucinosis and seizures. Since it may prove difficult to identify such patients and since there is also a small risk of the neuroleptic malignant syndrome (particularly with parenteral administration), the usefulness of tiapride in this setting is likely to be limited. The potential risk of tardive dyskinesia at the dosage used in alcoholic patients following detoxification (300 mg/day) requires evaluation and necessitates medical supervision. It is unlikely to produce problems of dependence or abuse. 

Agitation, anxiety, hyperrellexia, and life-threatening seizures + in ethanol withdrawal delusions/ hallucinations—delirium tremens (DTs)... 

Experimentally, benzodiazepines inhibit some types of seizure activity. Clonazepam, nitrazepam, and nordazepam have more selective anticonvulsant activity than most other benzodiazepines. Benzodiazepines also suppress ethanol-withdrawal seizures in human beings. However, the development of tolerance to the anticonvulsant effects has limited the usefulness of benzodiazepines in the treatment of recurrent seizure disorders (see Chapter 19). 

Treatment of cough associated with use of ACE inhibitors Suppression of the ethanol withdrawal syndrome... 

Ethanol withdrawal includes the excited hallucinatory state of delirium tremens. 

Sedative-hypnotio drug or ethanol withdrawal (delirium tremens). 

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