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Medication for Alcohol Withdrawal

Read on to learn more about the different types of medication for alcohol withdrawal, as well how medication is used in detox facilities and programs.

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Why are Medications Used During Alcohol Detox?

In severe cases, acute alcohol withdrawal has the potential to be life-threatening. This is because someone struggling with alcoholism who abruptly quits drinking is at risk of experiencing severe symptoms, including delirium, hallucinations, seizures, and problems with blood pressure, temperature, and pulse. Without proper intervention, seizures can lead to death.

Although hallucinations and delusions aren’t inherently fatal, they may result in dangerous situations, such as accidents, injuries, or erratic or violent behaviors.1,2

Seizures, which typically appear within 24 hours of the last drink, occur in up to 25 percent of individuals withdrawing from alcohol, and delirium tremens occurs in approximately 5 percent of patients.3 The symptoms of delirium tremens generally appear between two and four days after discontinuation of alcohol consumption.3

Am I At Risk for Severe Alcohol Withdrawal Symptoms?

Not everyone who struggles with alcohol abuse will experience severe or complicated withdrawal. The manifestation of acute alcohol withdrawal syndrome varies greatly from person to person. Those who are at very high risk during alcohol withdrawal include:2,3

  • Those with a history of delirium tremens or withdrawal seizures.
  • Those who have consumed high amounts of alcohol in the weeks prior to withdrawal.
  • Those who have been regular drinkers for two decades or more.
  • Older adults.
  • People with co-occurring mental health or physical conditions.
  • Those in poor general health, such as those with nutritional deficiencies.
  • Those who’ve suffered head trauma in the past.

What Type of Detox Should I Choose?

If you struggle with an addiction to alcohol, you’ll want to schedule an appointment with your doctor to receive a medical evaluation. Your physician will assess your risks by asking questions about a number of factors, including:2

  • Physical health
  • Mental health
  • Patterns of alcohol abuse
  • Concurrent use of any other substances
  • Past addiction treatment or detoxifications
  • Risk of suicide or violence

They will use this information to gauge your risk of experiencing a complicated withdrawal. If they feel you may be in danger of having a seizure or developing delirium tremens, they are likely to refer you to a medical inpatient detox facility. These programs provide you with 24-hour care, supervision, and monitoring, and medical staff can provide you with medications necessary to keep you safe during withdrawal.2

Is Inpatient Detox Right for Me?

Outpatient detox is reserved for people with little to no risk of dangerous withdrawal symptoms. There are several contraindications to outpatient detox. People who shouldn’t receive outpatient detox and instead should enroll in an inpatient program include those who:4

  • Have had multiple failed attempts at completing outpatient detox.
  • Have coronary artery disease or insulin-dependent diabetes.
  • Suffer from severe psychiatric disorders, such as suicidal thoughts or attempts, hallucinations, delusions, cognitive deficits, or psychosis.
  • Have a co-occurring sedative addiction.
  • Show signs of liver problems, such as jaundice.
  • Have a history of withdrawal delirium or seizures.
  • Fail to respond to medications with 1-2 days.
  • Are pregnant.
  • Don’t have a secure home setting or support network.
  • Are in an advanced state of withdrawal (hallucinations, high fever, delirium, etc.).

Entering an inpatient detox program for alcohol withdrawal can save your life. Medical staff members, such as doctors and nurses, are available to administer medications and provide supportive care to help you eliminate alcohol from your system safely and achieve a physically and psychologically stable state.

Medication for Alcohol Detox

Some medications are useful in managing acute alcohol withdrawal. These medications include:2

  • Benzodiazepines.
  • Phenobarbital and other types of bartbiturates.
  • Anticonvulsants.
  • Conlidine and other types of beta-blockers.
  • Antipsychotics.

Benzodiazepines for Alcohol Withdrawal

Benzodiazepines are a cross-tolerant with alcohol, meaning that they affect the same parts of the brain.5 As such, many programs consider benzodiazepines as the primary drug used to help alleviate the symptoms of alcohol withdrawal.5 Due to the cross-tolerant nature of the drug, benzos can be used as a substitute for alcohol, potentially mitigating withdrawal symptoms while the detoxification process continues.2

Barbiturates for Alcohol Withdrawal 

Despite being used for the treatment of alcohol withdrawal symptoms for many years, barbiturates are gradually falling out of usage.2  Many barbiturates are questionably effective at treating alcohol withdrawal symptoms, and the drug’s long half-life (length of time it stays in the body) and addictive qualities means that taking barbiturates other than prescribed or for extended periods could lead to addiction, overdose, or death. While a certain barbiturate, phenobarbital, continues to be used, this is usually done in highly supervised settings.2

Other Medications for Alcohol Withdrawal

There are three other types of medications that may be used in alcohol withdrawal, though their use tends to be less common. Generally, these medications will be used with specific symptoms appear during the withdrawal process. Some of these medication types include:

  • Anticonvulsants: Anticonvulsant medications are still being studies to determine their usefulness in treating alcohol withdrawal symptoms.2 Early studies show that certain anticonvulsant medications are effective in treating mild or moderate alcohol withdrawal, but may come with drawbacks of their own.2 Research still needs to be done to determine the full effectiveness of anticonvulsants, both old and new, in treating alcohol withdrawal, but those who are experiencing only mild withdrawal symptoms may be prescribed some of the medications.
  • Clonidine and other Beta-Blockers: Clonidine and beta-blockers are another type of medication that one may experience when receiving medical treatment for alcohol withdrawal. While beta-blockers are relatively ineffective at mitigating most withdrawal symptoms, they can be highly effective at reducing rapid heartbeat or high blood pressure during the process.2 As such, one may be prescribed clonidine and beta-blockers as supportive medications to help manage those specific symptoms.2
  • Antipsychotics: Antipsychotic medications may be prescribed to help mitigate certain alcohol withdrawal symptoms like agitation, hallucinations, delusions, or delirium.2 While these medications can be effective at reducing these withdrawal symptoms, many antipsychotics could reduce the seizure threshold, possibly putting the patient at higher risk for experiencing a seizure.2

When Can I Start Taking Medications for Alcohol Addiction?

It’s important to understand that some of the alcohol addiction medications cannot be taken during acute withdrawal and require a waiting period before initiation.

For example, the FDA recommends that naltrexone should not be used until alcohol withdrawal symptoms have dissipated. On average, this involves waiting at least three days after quitting drinking, with as many as seven if at all possible. This recommendation is due to the potential side effects of naltrexone, such as nausea, which may be heightened by the presence of alcohol.

That being said, taking naltrexone during medical detox or while drinking is not dangerous.7 Taking naltrexone within 7-10 days of quitting opioids, however, could cause precipitated opioid withdrawal, so patients detoxing from both alcohol and opioids may need to wait longer to initiate therapy.7

The FDA also approved acamprosate for relapse prevention maintenance once the person is already abstinent from alcohol. Acamprosate is not effective in decreasing or managing alcohol withdrawal symptoms. The FDA doesn’t indicate a specific time period that the individual must wait before initiating acamprosate use, but since alcohol detox may last several days, it is likely that at least a few days are necessary before introducing the medication.8

Because disulfiram interferes with alcohol metabolism, it should not be taken when the person has alcohol in their system. Disulfiram use should be initiated in patients who have been abstinent for at least 12 hours and their blood alcohol level is at 0.9