Alcohol withdrawal syndrome

Aubin HJ, Lehert P, Beaupere B, Parot P, Barrucand D. Tolerability of the combination of acamprosate with drugs used to prevent alcohol withdrawal syndrome. Alcoholism (1995) 31, 25-38. 

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. 

Dobrydnjov I, Axelsson K, Berggren L, et al Intrathecal and oral clonidine as prophylaxis for postoperative alcohol withdrawal syndrome a randomized double-blinded study. Anesth Analg 98 738—744, 2004... 

Myers RD, Melchior CL Differential actions on voluntary alcohol intake of tetra-hydroisoquinolines or a beta-carboline infused chronically in the ventricle of the rat. Pharmacol Biochem Behav 7 381-392, 1977 Naranjo CA, Sellers EM Clinical assessment and pharmacotherapy of the alcohol withdrawal syndrome, in Recent Developments in Alcoholism, Vol 4. Edited hy Galanter M. New York, Plenum, 1986... 

Gossop M, Bradley B, Phillips GT An investigation of withdrawal symptoms shown by opiate addicts during and subsequent to a 21 -day in-patient methadone detoxification procedure. Addict Behav 12 1-6, 1987 GreenJ, Jaffe JH Alcohol and opiate dependence. J Stud Alcohol 38 1274-1293,1977 Green L, Gossop M Effects of information on the opiate withdrawal syndrome. Br J Addict 83 305-309, 1988... 

Sellers EM Alcohol, barbiturate and benzodiazepine withdrawal syndromes clinical management. CMAJ 139 113—120, 1988... 

Cornelius JR, Salloum IM, EhlerJG, et al Fluoxetine in depressed alcoholics a doubleblind, placebo-controlled trial. Arch Gen Psychiatry 54 700—705, 1997 Cornelius JR, Salloum IM, Haskett RF, et al Fluoxetine versus placebo for the marijuana use of depressed alcoholics. Addict Behav 24 111—114, 1999 Cui S-S, Bowen RC, Gu G-B, et al Prevention of cannabinoid withdrawal syndrome by lithium involvement of oxytocinergic neuronal activation. J Neurosci 21 9867— 9876, 2001... 

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... 

Miotto K, Darakjian J, Basch J, et al Gamma-hydroxybutyric acid patterns of use, effects and withdrawal. Am J Addict 10 232-241, 2001 Moncini M, Masini E, Gambassi F, et al Gamma-hydroxybutyric acid and alcohol-related syndromes. Alcohol 20 285-291, 2000 Morgan MJ Memory deficits associated with recreational use of ecstasy (MDMA). 

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

Snyder FR, Davis FC, Henningfield JE. (1989). The tobacco withdrawal syndrome performance decrements assessed on a computerized test battery. Drug Alcohol Depend. 23(3) 259-66. 

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

Side effects of benzodiazepines include sedation, dizziness, poor coordination, and, at higher doses, amnesia. Benzodiazepines also increase the effects of alcohol therefore, alcohol use should be avoided or markedly curtailed. Benzodiazepines can also exacerbate the breathing problems of patients with sleep apnea and other respiratory disorders such as emphysema. Like the barbiturates, long-term use of benzodiazepines can lead to physical dependence, and abrupt discontinuation can produce an unpleasant, or even dangerous, withdrawal syndrome. 

However, there are disadvantages to benzodiazepines. They prodnce sedation and can impair short-term memory and coordination (psychomotor fnnction such as driving). They can magnify the effects of alcohol and are snbject to abuse and withdrawal syndromes. Refer to Section 5.1 for a more extended discussion of benzodiazepines. 

Drugs that block j32-receptors generally have a calming effect and are prescribed for anxiety, migraine, esophageal varices, and alcohol withdrawal syndrome, among others. 

There are various neurologic disorders which can be treated with jS-blockers like migraine, certain forms of tremor and alcohol withdrawal syndrome. Somatic manifestations of anxiety respond well to /3-adrenoceptor blockade. jS-Blockers with a selectivity for the jSi-subtype might be useful to avoid extracardial side effects. 

Antipsychotic agents are also used for a diversity of other indications like hiccups, Tourette s syndrome, aggressive behavior in children and the elderly and alcohol withdrawal syndrome. Some of them are also used in anesthesia as they can potentiate the sedative, analgesics or anesthetic effects of other agents. Antipsychotics which are mainly active by blocking dopamine activity have also an effect on chemoreceptor trigger zone and may therefore be used as anti-emetics. 

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 ... 

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. 

Alcohol withdrawal syndrome (acute) IV 100 mg per 25g of glucose concurrent administration with IV glucose. 

The Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar) is a short and practical ten-item instrument for clinical quantitation of the severity of an alcohol withdrawal syndrome. It can be incorporated into the usual clinical care of patients undergoing alcohol withdrawal and into clinical drug trials of alcohol withdrawal ( Sullivan et al.. 1989). 

It is associated with development of psychic dependence, tolerance and physical dependence and sudden withdrawal of alcohol may lead to withdrawal syndrome. 

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... 

Because lithium shows some utility in certain patients whose dual diagnosis includes bipolar disorder, and because the anticonvulsants attenuate several types of withdrawal syndromes, these agents may be useful and safe for selected alcoholic patients with bipolar and related disorders. 

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