Pharmacologic Options for the Treatment of Alcohol Withdrawal - 2000

 


Drug Dosing Schedule Advantages Disadvantages
Benzodiazepines
  Anticonvulsant effects Abuse potential; respiratory depression
Chlordiazepoxide (Librium) 20 to 100 mg orally or intravenously, every 6 hours Widely used Long half-life (30 to 60 hours); inject slowly; high hepatic metabolism
Diazepam (Valium) 5 to 20 mg orally or intravenously, every 6 hours Widely used Long half-life (30 to 60 hours); inject slowly; high hepatic metabolism
Lorazepam (Ativan) 1 to 2 mg orally, intravenously or intamuscularly, every 4 hours Intramuscular administration; lower hepatic metabolism Limited experience
Oxazepam (Serax) 15 to 30 mg orally, every 4 hours Short half-life (5 to 10 hours); lower hepatic metabolism No parenteral form
Adrenergic blockers   No abuse potential; limited oversedation risk No anticonvulsant effects
Clonidine (Catapres) 0.1 to 0.3 mg orally, three or four times daily No respiratory depression Hypotension
Propranolol (Inderal) 40 to 160 mg per day orally in three divided doses Arrhythmia prevention Higher hallucination risk;medical contraindications (congestive heart failure, bronchospasm, etc.); hepatically cleared
Carbamazepine (Tegretol) 200 mg orally, four times daily Anticonvulsant effects; no abuse potential Risk of hepatic toxicity and aplastic anemia; no parenteral form
Chlormethiazole   Anticonvulsant effects; sedating Dependency problems; respiratory depression

 


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