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Clinician’s Corner: Treatment of alcoholism, alcohol withdrawal

The final topic we will discuss regarding New Year’s Resolution would be of stopping drinking. Treatment of alcoholism, and alcohol withdrawal can be very challenging. Here are some of the very scary statistics of Alcohol Use Disorder (AUD)

Prevalence of Drinking:

In 2013, 86.8 percent of people ages 18 or older reported that they drank alcohol at some point in their lifetime; 70.7 percent reported that they drank in the past year; 56.4 percent reported that they drank in the past month.

Prevalence of Drinking (College Age): In 2013, 59.4 percent of full-time college students ages 18–22 drank alcohol in the past month compared with 50.6 percent of other persons of the same age

Adults (ages 18+): 16.6 million adults ages 18 and older (7%) had an AUD in 2013. This includes 10.8 million men (9.4%) and 5.8 million women (4.7%).

  • About 1.3 million adults received treatment for an AUD at a specialized facility in 2013 (7.8 percent of adults who needed treatment). This included 904,000 million men (8.0 percent of men in need) and 444,000 women (7.3 percent of women who needed treatment).

TREATMENT OF ALCOHOL DETOXIFICATION

Benzodiazepines are the mainstays of treatment for alcohol withdrawal, particularly inpatient, however anticonvulsants are becoming increasingly popular for outpatient detox due to good efficacy and a lower potential for abuse.

  • The doses of benzodiazepines used for alcohol detox are much higher than those used to treat anxiety
  • Adverse effects: Sedation, dizziness, delirium, hypotension, respiratory depression
Drug Dose Pros Cons
Chlordiazepoxide (Librium) 50-100mg Q 6 hours initially, then taper down Long acting, fewer breakthrough symptoms Very sedating
Diazepam (Valium) 10-20mg Q 6 hours initially, then taper down Fast onset of action, long acting Higher abuse potential
Lorazepam (Ativan) 2-4mg Q 6h, then taper down Less sedation Shorter acting, more breakthrough symptoms, unlabeled use
Oxazepam (Serax) 15-30mg QID, then taper down Less sedation, lower abuse potential, better for elderly patients or those with liver impairment Patients may experience more breakthrough or rebound symptoms

 

Anticonvulsants

  • Becoming increasingly popular for outpatient detox due to good efficacy and a lower potential for abuse
  • Use of anticonvulsants for alcohol detox should be considered in patients where there is a high potential for abuse, or for whom sedation poses a serious concern
  • Detox using anticonvulsants may be used in outpatient settings where withdrawal symptoms are less severe and patients are at a lower risk for serious complications

Carbamazepine (Tegretol)

Dosed: 200mg QID x 1 day, then 200mg TID x 1 day, then 200mg BID x 1 day, then 200mg QD x 2 days

  • Less sedating, and less abuse potential than benzos
  • Many drug interactions (enzyme inducer)-speeds up metabolism of other drugs
  • Watch for blood dyscrasias, liver failure, Stevens Johnson syndrome

Gabapentin (Neurontin)

Dosed 400mg TID x 3 days, then BID x 1 day. Three 100mg rescue doses may be used daily

  • Less sedating, and less abuse potential
  • Fewer drug interactions than carbamazepine

Next week we will discuss Alcohol Relapse Prevention Agents

Have a great day on the bench

Peter Kreckel   Thompson Pharmacy Broad Avenue