What are the main medicine treatments for alcohol withdrawal?

If you are prescribed a medicine, then there may be many reasons why that one has been chosen. These might include:

• side effects (which ones are important to you)
• local policies or agreements (such as what that GP surgery uses, in your area etc)
• national policies (e.g. NICE, SIGN - see last question)
• familiarity (it may be better to get best out of a medicine you are familiar with)
• relative costs for similar medicines
• personal preference (either yours or your prescriber)
• how bad your symptoms are
• any medicine you might have done well with in the past (as it's more likely to work again)

For convenience, the "Main medicines” are those medicines that are officially "approved" to treat the condition or or symptoms. They are listed in the British National Formulary (www.bnf.org/bnf/). To be listed in the BNF there needs to be good evidence that the medicine works and that the producers have applied for a license (a long and costly exercise). "Others" are those medicines where there is some evidence that they help, but either not enough for a license or that no license has been applied for. These should usually only be used where other standard treatments have failed.

Alcohol Withdrawal Syndrome can be life-threatening so it must be taken very seriously. If someone has been drinking higher amounts, it is usually a very good idea to go into hospital for a "detox" (detoxification), especially if the symptoms might be severe, there is a history of fits or seizures, Wernicke's Encephalopathy is possible or if there are physical or psychological problems.   

Main medicines:

• Benzodiazepines - there is a degree of "cross tolerance" with alcohol and so these will help stop fits or seizures. The dose usually depends on your symptoms e.g. blood pressure, pulse, agitation, and delirium (confusion). They usually start with a high loading dose (which depends on how bad the withdrawal symptoms are or might be), then reduced

  • Chlordiazepoxide - to help stop withdrawal seizures or fits, usually a 7 day course of reducing doses, slower onset but less chance of abuse   

  • Diazepam  - to help stop withdrawal seizures or fits, and has a slightly quicker onset

  • Lorazepam or oxazepam if there are liver problems

• Clomethiazole (Heminevrin®) - to help stop withdrawal seizures or fits. But has a higher risk of dependence, is really very toxic if you overdose (and that's not difficult to do) and can build up in the body if your liver is damaged. So although it is licensed, these problems mean it is rarely used as better medicines e.g. the benzodiazepines or some of the anticonvulsants, are much better and safer.

• Pabrinex ® - to give a rapid boost to dangerously low vitamin levels, which may drop even quicker or further during withdrawal or a detox

• Thiamine - to help a lack of the essential vitamin thiamine

• Vitamin B & C strong - to help a lack of thiamine and other vitamins

Others:

• Hypnotics, if needed to help sleep

• Baclofen - used in some areas

• Carbamazepine (Tegretol®) - to help stop withdrawal seizures or fits - it is not used routinely, and less likely to be successful in the long-term but can be useful sometimes

• Antipsychotics - if the person has lots of hallucinations or psychosis but can make fits more likely

Sometimes the symptoms caused by a lack of vitamins can be so severe that the person looks like they are intoxicated or drunk.

^{Updated 12.12}

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