Medicines for ETOH Withdrawal Flashcards
What is the preferred drug of choice for ETOH withdrawal
Oral diazepam (5-20mg doses if CIWA-Ar score >/=10) - doses required may range from 30 to 120mg in the first 24 to 48 hours. Initially 1-2hrly PRN dosing, later reducing to 2-6hrly PRN dosing when stable.
Diazepam is good in this setting because of its long half-life - hence it is better at preventing seizures, as well as providing sedation for agitated behaviour.
Lorazepam can be used, but most physicians are not as familiar with it. Dose is 1-3mg 2-6 hourly.
Midazolam and oxazepam are short-acting and hence generally not used.
Lorazepam or oxazepam are better for elderly or those with liver failure.
What is the MOA of benzodiazepines
Bind to GABA-A channels - increase frequency of opening to ligand –> increased Cl- influx –> CNS depressant effect
Alcohol also acts on these receptors
Dose of thiamine for ETOH withdrawal
thiamine 100mg (100mg/mL IV or IM) daily for 3 to 5 days
Thiamine must ALWAYS be given before administration of glucose
Can antipsychotics be used for ETOH withdrawal
Yes. Antipsychotics such as haloperidol are second-line agents to help control marked agitation or hallucinations. If used alone they are associated with a higher rate of complications such as seizures and delirium tremens.
Haloperidol is a good choice. Chlorpromazine has a slower onset of effect, is more sedative and may be less effective. Olanzapine is not a good choice because of its long time to onset and long half life, which makes it very difficult to titrate the dose to an appropriate effect.
Aside from thiamine, benzodiazepines and antipsychotics, what other medication may be considered in ETOH withdrawal
Agents which reduce sympathetic activity, such as propranolol or clonidine, may have a role in conjunction with benzodiazepines for the control of symptoms such as tachycardia and tremor
Anticonvulsants such as carbamazepine are only used in patients who are actively fitting
