Alcohol withdrawal: Outpatient management

Background

• Consider discharge with 3 day course of benzodiazepines if patients are attempting to quit alcohol
• Possible exclusions for outpatient treatment:
  • 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
  • Some protocols call for higher dosing - 600 or 800mg x1
• Similar efficacy to lorazepam in decreasing craving and anxiety

• 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

• 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

• MDCalc - CIWA-AR Calculator