Alcohol withdrawal: Outpatient management: Difference between revisions
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=Background= | |||
*Consider discharge [[EBQ:Outpatient use of benzodiazepines for the treatment of acute alcohol withdrawl|with 3 day course of benzodiazepines if patients are attempting to quit alcohol]] | |||
*Possible exclusions for outpatient treatment<ref>Myrick et al. A DOUBLE BLIND TRIAL OF GABAPENTIN VS. LORAZEPAM IN THE TREATMENT OF ALCOHOL WITHDRAWAL. Alcohol Clin Exp Res. 2009 Sep; 33(9): 1582–1588. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769515/</ref>: | |||
**Substance use disorders except alcohol, nicotine, or cannabis | |||
**Major Axis I psych disorder | |||
**Medication hx of benzodiazepines, BBs, CCBs, antipsychotics | |||
**Hx of head injury, epilepsy, medical instability, ECG abnormality, grossly abnormal lab value | |||
==Management== | ==Management== | ||
===[[Chlordiazepoxide]]=== | ===[[Chlordiazepoxide]]=== | ||
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*Similar efficacy to lorazepam in decreasing craving and anxiety<ref>Myrick, H et al. A double-blind trial of gabapentin versus lorazepam in the treatment of alcohol withdrawal. Alcohol Clin Exp Res. 2009 Sep;33(9):1582-8. PMID: 19485969</ref> | *Similar efficacy to lorazepam in decreasing craving and anxiety<ref>Myrick, H et al. A double-blind trial of gabapentin versus lorazepam in the treatment of alcohol withdrawal. Alcohol Clin Exp Res. 2009 Sep;33(9):1582-8. PMID: 19485969</ref> | ||
*Example regimens (please use discretion and balance risk/benefits with your own clinical judgment) | |||
====Example outpatient [[lorazepam]] taper==== | ====Example outpatient [[lorazepam]] taper==== | ||
*2 mg tid x3 days | *2 mg tid x3 days | ||
Revision as of 17:52, 15 February 2016
Background
- Consider discharge with 3 day course of benzodiazepines if patients are attempting to quit alcohol
- Possible exclusions for outpatient treatment[1]:
- Substance use disorders except alcohol, nicotine, or cannabis
- Major Axis I psych disorder
- Medication hx of benzodiazepines, BBs, CCBs, antipsychotics
- Hx of head injury, epilepsy, medical instability, ECG abnormality, grossly abnormal lab value
Management
Chlordiazepoxide
Generally for outpatient treatment of mild cases and as a taper
- 25-50mg of chlordiazepoxide is equivalent to 10mg of diazepam
- 50mg of chlordiazepoxide every 8 hours for two days, thel decrease to 25mg every 8 hours for another two days followed by 25mg PRN as needed.
Anticonvulsants
- Gabapentin 400mg PO TID[2]
- Some protocols call for higher dosing - 600 or 800mg x1
- Similar efficacy to lorazepam in decreasing craving and anxiety[3]
- Example regimens (please use discretion and balance risk/benefits with your own clinical judgment)
Example outpatient lorazepam taper
- 2 mg tid x3 days
- 2 mg bid on day 4
- 2 mg once on day 5
Example outpatient gabapentin taper
Similar in efficacy to lorazepam according to one RCT[4]
- 400 mg tid x3 days
- 300 mg bid on day 4
- 300 mg once on day 5
See Also
- Beer Potomania Syndrome
- Alcohol (ETOH) Intoxication
- Alcoholic ketoacidosis
- Alcohol withdrawal
- Alcohol withdrawal: Inpatient management
- Alcohol withdrawal: Outpatient management
- Alcohol withdrawal seizures
- Altered mental status
- Delerium tremens
- EBQ:Outpatient use of benzodiazepines for the treatment of acute alcohol withdrawal
- Sedative/Hypnotic
- Wernicke-Korsakoff Syndrome
External Links
References
- ↑ Myrick et al. A DOUBLE BLIND TRIAL OF GABAPENTIN VS. LORAZEPAM IN THE TREATMENT OF ALCOHOL WITHDRAWAL. Alcohol Clin Exp Res. 2009 Sep; 33(9): 1582–1588. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769515/
- ↑ Leung JG, Hall-Flavin D, Nelson S, et al. The role of gabapentin in the management of alcohol withdrawal and dependence. Ann Pharmacother. 2015; 49(8):897-906.
- ↑ Myrick, H et al. A double-blind trial of gabapentin versus lorazepam in the treatment of alcohol withdrawal. Alcohol Clin Exp Res. 2009 Sep;33(9):1582-8. PMID: 19485969
- ↑ Myrick et al. A DOUBLE BLIND TRIAL OF GABAPENTIN VS. LORAZEPAM IN THE TREATMENT OF ALCOHOL WITHDRAWAL. Alcohol Clin Exp Res. 2009 Sep; 33(9): 1582–1588. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769515/