Ambulatory management of alcohol withdrawal
- Stephen R Holt, MD, MS, FACP
Stephen R Holt, MD, MS, FACP
- Assistant Professor of Medicine
- Yale School of Medicine
- Jeanette M Tetrault, MD, FACP, FASAM
Jeanette M Tetrault, MD, FACP, FASAM
- Associate Professor of Medicine
- Yale University School of Medicine
Patients with alcohol use disorder may experience a withdrawal syndrome when they abruptly stop or sharply reduce consumption. Mild withdrawal symptoms can include anxiety, agitation, restlessness, insomnia, tremor, diaphoresis, palpitations, headache, and alcohol craving, and often loss of appetite, nausea, and vomiting. Symptoms of more severe withdrawal can additionally include hallucinations as well as seizures or delirium tremens; the latter two can be life-threatening.
Medically supervised alcohol withdrawal is indicated for patients with or at risk of withdrawal symptoms. For patients with mild symptoms and no history of seizures or delirium tremens, supervised withdrawal can be managed safely and effectively in the ambulatory setting. Patients with more severe symptoms and/or at risk of delirium tremens, seizures, or hallucinations require closer monitoring and intervention, typically in an inpatient setting.
This topic reviews ambulatory management of mild alcohol withdrawal. Management of inpatients with moderate to severe withdrawal are reviewed separately. The epidemiology, clinical manifestations, course, assessment, and diagnosis of alcohol withdrawal are also reviewed separately. The epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis of alcohol use disorder are also reviewed separately. (See "Management of moderate and severe alcohol withdrawal syndromes" and "Alcohol withdrawal: Epidemiology, clinical manifestations, course, assessment, and diagnosis" and "Risky drinking and alcohol use disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis".)
APPROACH TO TREATMENT
Assessment — Patients with alcohol use disorder presenting clinically for medically supervised alcohol withdrawal should receive an initial evaluation that includes:
●Substance use history – Questions influencing decision-making regarding supervised withdrawal include (see "Clinical assessment of substance use disorders"):To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- APPROACH TO TREATMENT
- Need for treatment
- Ambulatory criteria
- Selecting a medication
- - Complications
- - Supportive care
- EFFICACY AND SAFETY OF AMBULATORY WITHDRAWAL
- MEDICATION OPTIONS
- - Shorter- versus longer-acting
- - Symptom-triggered versus fixed dosing
- Very mild withdrawal
- Mild withdrawal
- - Gabapentin
- - Carbamazepine
- - Other anticonvulsants
- Other medications
- POSTWITHDRAWAL TREATMENT
- SUMMARY AND RECOMMENDATIONS