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Colin MacKenzie M.D.
October 19, 2020

The medical community uses many different medications during the pre-detox, detox, and post-detox periods of alcohol withdrawal.  Some of these medications have been utilized for decades and others have been added to the armamentarium more recently. 

We can categorize the medications used for alcohol withdrawal into groups based on function and purpose.  For organizational purposes, I will separate the medications used into five groups

  1. Vitamins and supplements, 
  2. Anticonvulsants,
  3. Antipsychotics,
  4. Antihypertensives Medications, 
  5. Gaba-Receptor Agonists (withdrawal-suppression meds), and
  6. Anti-Relapse Medications.

I will briefly describe the medications here and then go into more detail of each group in subsequent blog entries. 

Vitamins and Supplements

  The administration of vitamins and supplements are critical to a successful alcohol detoxification.  Alcohol can be a “triple-threat” to one’s vitamin health as it can lead to absolute and relative vitamin deficiencies in three ways: Poor dietary intake, poor absorption and storage, and direct impairment of vitamin function. The vitamins, supplements, and minerals of most concern in alcohol detox include:

vitamin capsule
  1. Vitamin B1 (Thiamine)
  2. Vitamin B6 (Pyridoxine)
  3. Vitamin B9 (Folate)
  4. Vitamin B12 (Cobalamin)
  5. Electrolytes (sodium, potassium, calcium, magnesium)
  6. Glucose (a simple carbohydrate)
  7. Water/hydration status (H2O)

Sedative-Hypnotics (Benzodiazepines)

  The primary medications used for alcohol withdrawal are benzodiazepines, sometimes called “benzos”.  These medications have proven to be the most effective medications to suppress the symptoms of withdrawal (agitation, sweating, tremor, cravings) and to also decrease the risk of alcohol withdrawal seizures and delirium tremens (“DT’s”).  These medications are also commonly used to treat anxiety disorders.  Members of this class of medications include:

  1. Chlordiazepoxide (Librium)
  2. Diazepam (Valium)
  3. Lorazepam (Ativan)

Click here for an in-depth review of the Sedative-Hypnotic medications.

Antipsychotics

Antipsychotics should be used rarely in the context of alcohol withdrawal. Antipsychotics can lower the seizure threshold making alcohol withdrawal seizures more likely.  When psychotic symptoms become manifest within withdrawal, such as during alcohol hallucinosis or delirium tremens, it is imperative that the standard withdrawal medications be optimized. However, there are certain instances where using an antipsychotic can be helpful or necessary.  In those with a primary psychotic illness, such as a patient with schizophrenia who is experiencing an exacerbation of delusions, would be a candidate for antipsychotic treatment during alcohol withdrawal.   Some antipsychotics include:

  1. Haloperidol (Haldol)
  2. Olanzapine (Zyprexa)
  3. Quetiapine  (Seroquel)

Anticonvulsants 

Many type of anticonvulsants have been used to manage alcohol withdrawal.  They have a mixed benefit profile in alcohol withdrawal treatment with some research studies suggesting benefits while others do not.  Some members of this group are also used during the chronic withdrawal symptom period to alleviate symptoms that can linger for months after acute treatment is completed. These medications include the following:

  1. Gabapentin (Neurontin)
  2. Carbamazepine (Tegretol)
  3. Valproic Acid (Depakote)
  4. Topiramate (Topamax)

Antihypertensives

Blood pressure lowering medications have been used in the treatment of alcohol withdrawal, though they are not used as a primary treatment during either the acute or post-acute phases of withdrawal.  Regardless, they can be useful for the treatment of extreme hypertension and tachycardia without the risk of respiratory drive suppression.  These medications include:

  1. Clonidine (catapress)
  2. Dexmedetomidine (Precedex )
  3. Propranolol (Inderal)

Anti-Relapse Medications 

Several medications are now being used to decrease the risk of relapse.  Some work to reduce cravings and others employ a “punishment” when alcohol is consumed to extinguish addictive behaviors.  They all work via different mechanisms and some can be combined for an additive effect.  Some of these medications include:

  1. Naltrexone (ReVia)
  2. Acamprosate (Campral)
  3. Disulfiram (Antabuse)
  4. Vivitrol (Naltrexone XR Injectable)

In future blog entries, we will be providing in-depth descriptions of each class of medications including how they are used, their mechanisms of actions, and potential side effects. 

 

 


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