Alcohol Withdrawal Medications

Alcohol can be safe in moderation, but too much alcohol can be harmful. When people abuse alcohol over the long-term, they may develop an alcohol addiction.

One of the symptoms of an alcohol use disorder, or addiction to alcohol, is withdrawal. This occurs when the body becomes dependent upon alcohol and cannot function properly without it. When a person develops and alcohol dependence, he or she will experience uncomfortable withdrawal symptoms when alcohol use is stopped or significantly reduced.

According to a report in the Industrial Psychology Journal, mild alcohol withdrawal begins about six hours after a person stops using alcohol and involves symptoms such as tremors, sweating, fast heart rate, upset stomach, headache, and anxiety. Some people may also experience hallucinations when they withdraw from alcohol. In some cases, withdrawal may progress to more severe symptoms, such as withdrawal seizures or a serious condition called delirium tremens, which causes severe confusion and may be fatal.

Common Medications for Alcohol Withdrawal

Alcohol withdrawal medications can alleviate some of the above symptoms and provide patients with relief as they detox from alcohol. In some cases, they may even be necessary to prevent serious health problems or death. A variety of alcohol withdrawal medications is available.

Diazepam (Valium)

Diazepam Valium Bottles
Diazepam (Valium) Bottles

As the authors of the report in the Industrial Psychiatry Journal explained, benzodiazepine drugs are the medication of choice for treating alcohol withdrawal, as they can alleviate withdrawal symptoms and prevent serious alcohol withdrawal complications, such as seizures and delirium tremens.

Among the benzodiazepines is a drug called Valium, which some people may recognize by its generic name, diazepam. Per a report in America Family Physician, the typical Valium dosage for alcohol withdrawal is a 10 milligram pill. Someone who follows a fixed dosage schedule for Valium will usually take a 10 milligram pill every six hours at the start of withdrawal, with dose frequency tapering off as symptoms improve over time. 

Valium tends to be a preferred medication for treating alcohol withdrawal, as it is long-acting, meaning that it has prolonged effects and can successfully prevent delirium tremens. 

Chlordiazepoxide (Librium, Libritabs, Poxi, Mitran

Chlordiazepoxide, commonly known by the brand name Librium, is another preferred benzodiazepine for the treatment of alcohol withdrawal. Like Valium, Librium is long-acting, but the dosage tends to be larger for Librium than for Valium. For instance, the typical Librium dose for alcohol withdrawal begins at 25 to 50 milligrams every 6 hours on a fixed schedule, eventually tapering to 25 to 50 milligrams at bedtime by the fifth day of treatment. 

Lorazepam (Ativan) 

Another benzodiazepine drug that may be preferred for the treatment of alcohol withdrawal is Ativan, also known as its generic name lorazepam. Lorazepam is an intermediate-acting benzodiazepine, which can also be effective for alcohol withdrawal. An intermediate-acting drug like Ativan is typically better for those who have liver problems, but caution should be used in those who have a history of drug addiction, as Ativan has a higher risk of abuse than Valium and Librium do.  

The typical dose of Ativan or lorazepam for alcohol withdrawal is 2 milligrams, given every 8 hours to begin. As time progresses and withdrawal symptoms subside, the dose is reduced to 1 milligram at bedtime. 

Gabapentin (Gralise, Horizant, Neuraptine)

While benzodiazepines are typically the medication of choice for treating alcohol withdrawal symptoms, they are not the only type of drug used for this purpose. Other drugs, including gabapentin, may be used to alleviate alcohol withdrawal. According to American Family Physician, research shows that gabapentin is just as effective as Ativan is for treating alcohol withdrawal symptoms. Per the U.S. National Library of Medicine, gabapentin is an anticonvulsant medication, meaning it treats seizures. This may make it effective for managing alcohol withdrawal, given the fact that seizures are possible during severe withdrawal episodes.

Baclofen (Lioresal, Gablofen)

Another non-benzodiazepine medication that may be useful for treating alcohol withdrawal is baclofen. This medication is a muscle relaxant and is typically used to treat pain and muscle tightness, but research suggests it is also effective for alleviating alcohol withdrawal symptoms. In fact, a study in the Journal of Hospital Medicine found that patients who were treated with baclofen were less likely to need high doses of benzodiazepines to treat alcohol withdrawal symptoms.

Phenobarbital (Solfoton, Luminal)

Phenobarbital is another alcohol withdrawal medication that may be used instead of benzodiazepines. This medication belongs to a class of drugs called the barbiturates, which are used as sedatives and to control seizures. A 2011 study in the American Journal of Emergency Medicine found that phenobarbital was just as effective as Ativan was for treating alcohol withdrawal symptoms. Phenobarbital therefore may be an alternative to benzodiazepine drugs, or may be used for those who do not respond to the benzodiazepines.

Pregabalin (Lyrica, Lyrica CR)

Pregabalin, otherwise known by its brand name, Lyrica, is also useful for treating alcohol withdrawal symptoms. Doctors typically prescribe pregabalin to treat nerve pain or seizures. According to a 2016 report in CNS Drugs, the research has shown that pregabalin is also highly effective for treating alcohol withdrawal. A two-week study found that pregabalin doses of around 300 milligrams per day decreased alcohol withdrawal symptoms and cravings. One study even found that pregabalin was superior to Ativan for keeping people abstinent from alcohol.

Trazodone (Desyrel, Desyrel Dividose, Oleptro)

While some medications may be used instead of benzodiazepines for treating alcohol withdrawal, others may be used alongside the benzodiazepines. One such drug is trazadone, an antidepressant medication. According to a study in Pharmacopsychiatry, trazadone can help with the management of withdrawal symptoms like sleep problems and alcohol cravings. In a case study with a patient who did not respond to benzodiazepines alone, 600 milligrams of trazadone per day was effective for alleviating alcohol withdrawal.

Thiamine (Vitamin B1)

Thiamine is another add-on treatment that may be utilized during alcohol withdrawal. As the authors of a 2013 study in Alcohol and Alcoholism have reported, people who are dependent upon alcohol may be deficient in thiamine due to having poor diets. This means that supplementation may be necessary. This is especially important for the prevention of a condition called Wernicke–Korsakoff’s syndrome. The syndrome is caused by a lack of the thiamine, which is an important vitamin. It results in brain damage and symptoms such as memory problems, confusion, and poor coordination.

Thiamine and various prescription medications may be necessary to treat alcohol withdrawal symptoms and prevent serious complications arising from alcohol abuse and withdrawal. While some people may experience only minor alcohol withdrawal symptoms that do not require medications, others will suffer from severe withdrawal symptoms, such as seizures and delirium tremens.

Given the fact that alcohol withdrawal comes with a risk of severe and potentially fatal side effects, it is important to seek treatment when undergoing alcohol withdrawal. Giving up drinking without medical intervention can be dangerous for those who are dependent upon alcohol. The alcohol withdrawal medications listed herein can make the withdrawal process more comfortable, and they may even be life-saving in the case of seizures or delirium tremens. While benzodiazepines like Valium, Ativan, and Librium appear to be the gold standard for treating alcohol withdrawal, other alcohol withdrawal medications or supplements may also be useful.

Sources & Resources

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