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Alcohol detoxification

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Alcohol detoxification or 'detox' for alcoholics is an abrupt stop of alcohol drinking coupled with the substitution of drugs that have similar effects in order to prevent alcohol withdrawal. Detoxification may or may not be necessary depending upon an individual's age, medical status, and history of alcohol intake. For example, a young man who binge drinks and seeks treatment one week after his last use of alcohol may not require detoxification before beginning treatment for alcoholism. Benzodiazepines are the most common family of drugs used for this[1], followed by barbiturates[How to reference and link to summary or text].

BenzodiazepinesEdit

Detoxes are performed in multiple ways:

  1. The first option takes into consideration the varying degrees of tolerance. In it, a standard dose of the benzodiazepine is given every half hour until light sedation is reached. Once a baseline dose is determined, the medication is tapered over the ensuing 3-10 days.
  2. Another option is to give a standard dose of benzodiazepine based on history and adjust based on withdrawal phenomenon.
  3. A third option is to defer treatment until symptoms occur. This method should not be used in patients with prior alcohol related seizures. This has been effective in randomized controlled trials.[2][3] A non-randomized, before and after, observational study found that symptom triggered therapy was advantageous.[4]

Dosing of the benzodiazepines can be guided by the CIWA-Ar scale.[5] The scale is available online.[6]

Regarding the choice of benzodiazepine:

  • Lorazepam or diazepam are available parenterally for patients who cannot safely take medications by mouth.
  • Lorazepam and oxazepam may be best in patients with cirrhosis (shorter half life).

SympatholyticsEdit

Randomized controlled trials have found benefit from atenolol[7] and clonidine.[8]

CarbamazepineEdit

A randomized controlled trial has found benefit from carbamazepine.[9]

Other drugsEdit

Some hospitals administer alcohol to prevent alcohol withdrawal although there are potential problems with this practice.[10]

See alsoEdit

ReferencesEdit

  1. Mayo-Smith MF (1997). Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal. JAMA 278 (2): 144-51. Full text at OVID
  2. Saitz R, Mayo-Smith MF, Roberts MS, Redmond HA, Bernard DR, Calkins DR (1994). Individualized treatment for alcohol withdrawal. A randomized double-blind controlled trial. JAMA 272 (7): 519-23.
  3. Daeppen JB, Gache P, Landry U, et al (2002). Symptom-triggered vs fixed-schedule doses of benzodiazepine for alcohol withdrawal: a randomized treatment trial. Arch. Intern. Med. 162 (10): 1117-21.
  4. Jaeger TM, Lohr RH, Pankratz VS (2001). Symptom-triggered therapy for alcohol withdrawal syndrome in medical inpatients. Mayo Clin. Proc. 76 (7): 695-701.
  5. Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM (1989). Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). British journal of addiction 84 (11): 1353-7.
  6. Holbrook AM, Crowther R, Lotter A, Cheng C, King D (1999). Diagnosis and management of acute alcohol withdrawal. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 160 (5): 675-80. (see appendix 2)
  7. Kraus ML, Gottlieb LD, Horwitz RI, Anscher M (1985). Randomized clinical trial of atenolol in patients with alcohol withdrawal. N. Engl. J. Med. 313 (15): 905-9.
  8. Baumgartner GR, Rowen RC (1987). Clonidine vs chlordiazepoxide in the management of acute alcohol withdrawal syndrome. Arch. Intern. Med. 147 (7): 1223-6.
  9. Malcolm R, Ballenger JC, Sturgis ET, Anton R (1989). Double-blind controlled trial comparing carbamazepine to oxazepam treatment of alcohol withdrawal. The American journal of psychiatry 146 (5): 617-21.
  10. Blondell RD, Dodds HN, Blondell MN, et al (2003). Ethanol in formularies of US teaching hospitals. JAMA 289 (5): 552.

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