Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond PMC

We searched Pubmed for articles published in English on pharmacological management of alcohol withdrawal in humans with no limit on the date of publication. Articles not relevant to clinical management were excluded based on the titles and abstract available. Full-text articles were obtained from this list and the cross-references.

Alcohol withdrawal may range from a mild and uncomfortable disorder to a serious, life-threatening condition. Driessen M, Lange W, Junghanns K, Wetterling T. Proposal of a comprehensive clinical typology of alcohol withdrawal – A cluster analysis approach. The risk factors for DT were analyzed by Ferguson et al. and further factors are tabulated in Table 4. In most cases, it is secondary to a general medical condition causing disturbance in the basic functions of the brain.

While studies have shown baclofen may be effective in reducing symptoms of alcohol withdrawal, including tremors, it is an “off-label” use of the drug at this time. BZD’s are the drugs of choice for AWS in most of the treatment settings; however, anti-convulsant drugs may represent suitable alternatives. There are several potential advantages to using anti-convulsant drugs. Use of an anti-convulsant drug decreases the probability of a patient experiencing a withdrawal seizure, thereby reducing the complications of AWS. Anti-convulsant drugs have been shown to block kindling in brain cells.

What Are The Symptoms Of Alcohol Withdrawal?

The condition is most likely to occur in people who are severely addicted to alcohol and have experienced alcohol withdrawal in the past. When someone with alcohol dependence stops drinking the sudden absence of alcohol in their body shocks their nervous system, which causes withdrawal. To avoid withdrawal people who are addicted to alcohol drink compulsively, even though they know that alcohol is harming their health and their relationships. Alcohol withdrawal is not only physically dangerous, but it’s also a major obstacle to overcoming alcohol addiction.

Of the patients in the symptom-triggered group, 61 percent did not receive any oxazepam. This trial excluded persons with major psychiatric, cognitive, or medical comorbidities. Have a confidential, completely free conversation with a treatment provider about your financial options. Isbell H, Fraser HF, Wikler A, Belleville RE, Eisenman AJ. An experimental study of the etiology of “rum fits” and delirium tremens.

• Alcohol withdrawal syndrome with alcohol withdrawal seizures and/or delirium

All patients with seizures or DT should have immediate intravenous access for administration of drugs and fluids. Adequate sedation should be provided to calm the patient as early as possible and physical restraints may be used as required in order to prevent injuries due to agitation. Adequate nutrition must be ensured with care to alcohol addiction & abuse prevent aspiration in over-sedated patients. Vitamin B supplementation helps to prevent Wernicke’s encephalopathy . In the Western world about 15% of people have problems with alcoholism at some point in time. Alcohol depresses the central nervous system, slowing cerebral messaging and altering the way signals are sent and received.

During an exam, they’ll look for other medical conditions to see if they could be to blame. When the alcohol level suddenly drops, your brain stays in this keyed up state. Other conditions that may present similarly include benzodiazepine withdrawal syndrome . Americanaddictioncenters.org needs to review the security of your connection before proceeding. Although home remedies are unreliable, there are some tips that may help ease the discomfort. Alcohol withdrawal happens because continued alcohol use changes the sensitivity of receptors in your brain.

Barbiturates are cross tolerance to alcohol and can ease withdrawal symptoms significantly. However, controlled studies have not provided sufficient data to demonstrate that these agents can prevent seizures or DT’s. Alcohol also acts on N-methyl-D-aspartate receptor as an antagonist, thereby decreasing surprising ways alcohol may be good for you the CNS excitatory tone. Therefore, chronic use of alcohol leads to an up regulation of glutamate to maintain CNS homeostasis. If you go to the hospital for another reason, tell the providers if you’ve been drinking heavily so they can monitor you for symptoms of alcohol withdrawal.

• Six to 12 hours after the ingestion of the last drink, withdrawal symptoms such as shaking, headache, sweating, anxiety, nausea or vomiting may occur.
• It could be due to infection, toxic, metabolic, traumatic or endocrine disturbances.
• The initial symptoms of alcohol detox are mild, but can quickly begin to worsen as time goes on.
• Maybe you decided to go back to drinking just to relieve those symptoms.

Chronic use of alcohol leads to changes in brain chemistry especially in the GABAergic system. Various adaptations occur such as changes in gene expression and down regulation of GABAA receptors. During acute alcohol withdrawal, changes also occur such as upregulation of alpha4 containing GABAA receptors and downregulation of alpha1 and alpha3 containing GABAA receptors. Neurochemical changes occurring during alcohol withdrawal can be minimized with drugs which are used for acute detoxification.

Managing Alcohol Withdrawal Symptoms at Home

12 to 48 hours, you may experience more serious symptoms, including hallucinations or even seizures. Therefore, it’s important to have someone you trust with you during the detox period. We’re here 24/7 to help guide you or your loved on through rehab and recovery. Submit your number to receive a call today from a treatment provider. As you approach the end of the first 24 hours of detox, symptoms may become increasingly severe. Alongside the effects felt from the first 12 hours, additional symptoms may involve disorientation, hand tremors and seizures.

However, it is feasible only in relatively stable patients and requires periodic monitoring of the withdrawal severity by trained personnel. For management of severe withdrawals, inpatient care and SML dose is advised. Though rapid loading is advised in DT, the few trials and retrospective chart reviews in DT have used a loading dose regimen.

Fruits and vegetables contain a lot of fiber that helps with digestion which can make it easier on your stomach when going through withdrawal symptoms such as nausea or vomiting. Adjunctive treatment with a beta blocker should be considered in patients with coronary artery disease, who may not tolerate the strain that alcohol withdrawal can place on the cardiovascular system. Clonidine also has been shown to improve the autonomic symptoms of withdrawal.10 Although phenytoin does not treat withdrawal seizures, it is an appropriate adjunct in patients with an underlying seizure disorder. In addition, recovery centers often have therapists and counselors on staff to talk to patients and help them manage their emotions as they progress through detox.

• Choice of Benzodiazepine

Symptoms of alcohol withdrawal have been described at least as early as 400 BC by Hippocrates. It is not believed to have become a widespread problem until the 1700s. If you or someone you love is struggling with alcohol abuse and addiction, The Recovery Village Columbus can help. We provide comprehensive alcohol addiction care that includesmedical detox, rehab and other follow-up services.Contact ustoday to learn more about how we can help you start your journey to lasting recovery.

They can range from mild to severe and are usually proportionate to the amount of alcohol you usually consumed and how long you’ve been drinking. Another medication used in the treatment of alcoholism is disulfiram. Unlike other medications, disulfiram works by producing severe reactions if alcohol is consumed. For instance, if you drink while on disulfiram, you will experience unwanted effects like facial flushing, nausea, headache, weakness and low blood pressure.

Treating Alcoholism

Uncontrollable shaking, usually in the hands, is a common sign of alcohol withdrawal. The shakes also called tremors can begin 6-10 hours after the last drink, and tend to be the most pronounced from the last alcohol consumption. Stuppaeck CH, Deisenhammer EA, Kurz M, Whitworth AB, Hinterhuber H. The irreversible gamma-aminobutyrate transaminase inhibitor vigabatrin in the treatment of the alcohol withdrawal syndrome. Mayo-Smith MF. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal.

Tsai G, Gastfriend DR, Coyle JT. The glutamatergic basis of human alcoholism. Dodd PR, Beckmann AM, Davidson MS, Wilce PA. Glutamate mediated transmission, alcohol, and alcoholism. Ng SKC, Hauser WA, Brust JCM, Susser M. Alcohol consumption and withdrawal in new-onset seizures. Symptoms such as sleep changes, rapid changes in mood, and fatigue may last for months.

Certain foods are good for everyone when they are recovering from alcohol detox. The food should help you get back to a healthy balance, and it should start at the beginning of recovery. An important concept in both alcohol craving and alcohol withdrawal is the “kindling” phenomenon; the term refers to long-term changes that occur in neurons after repeated detoxifications. Recurrent will beer cause acid reflux detoxifications are postulated to increase obsessive thoughts or alcohol craving.5 Kindling explains the observation that subsequent episodes of alcohol withdrawal tend to progressively worsen. Myrick H, Malcolm R, Brady KT. Gabapentin treatment of alcohol withdrawal. Malcolm R, Myrick H, Brady KT, Ballenger JC. Update on anticonvulsants for the treatment of alcohol withdrawal.

The advances in knowledge of neurobiology and neurochemistry have prompted the use of drugs in the treatment of alcohol withdrawal that act through “t GABA pathways”, such as the Baclofen, which are GABA-B pathways . Addolorato et al., reported a case series with five patients in which a single 10-mg dose of Baclofen resulted in relief of severe withdrawal symptoms . In a preliminary RCT by the first author in 2002, Baclofen also reduced craving in alcohol-dependent patients . A study found that the efficacy of Baclofen in treatment of uncomplicated AWS was comparable to that of the “gold standard” diazepam, with significantly decreased CIWA-Ar scores . Symptom triggered regimen – benzodiazepines are administered according to the withdrawal symptoms as assessed by withdrawal rating scales e.g. CIWA- AR. The ratings are done at a fixed schedule and drug doses are administered as per withdrawal severity.

In practice, loading dose strategy can be safely administered in DT. Vital signs should be used to guide treatment in “DT-plus” condition as these patients have been noted to have failure of loading-dose regimen with falsely high CIWA-Ar scores. Treatment of alcohol withdrawal delirium DT is defined by the goal of achieving a calm, but awake state or light somnolence defined as a sleep from which the patient is easily aroused. This goal is best achieved by the use of intravenous diazepam administered at frequent intervals while closely monitoring the patient during the procedure.

Vitamin supplements, particularly B vitamins such as thiamine) can be helpful for relieving some of the symptoms of alcohol withdrawal. Other supplements that your healthcare provider may recommend include vitamin C, calcium, and omega-3 fatty acids. Always talk to your doctor about any supplements you are taking and never take more than the recommended dose. Alcohol is a depressant that your body begins to rely on over the course of months and years of drinking. Your brain eventually stops producing certain chemicals that it receives from alcohol, becoming dependent on the drug.