Management of alcohol withdrawal

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Assessment

Effective assessment is key to successful treatment.

If there is a suspicion of alcohol misuse prior to admission a formal assessment of the patient’s alcohol use must be undertaken.

Severity of Alcohol Dependence Questionnaire (SAD-Q) should be completed.

The completed SAD-Q will be filed in the patient’s care record and the score obtained will be entered on to the fixed dose Chlordiazepoxide regime.

Chlordiazepoxide fixed regime

NICE guidelines recommend the use of fixed or symptom triggered dosing regimens with either chlordiazepoxide or diazepam to manage alcohol withdrawal.

In GG&C mental health services, chlordiazepoxide is the drug of choice using a fixed dose regime (see chart on page 3-4). 

The starting dose chosen will depend on the SAD-Q obtained and the clinical judgement of the prescribing doctor.

In the event of known liver impairment, consideration should be given to using alternative benzodiazepines e.g. oxazepam. Contact pharmacy services for advice in these circumstances.

Vitamin supplementation

Appropriate vitamin supplementation is essential to mitigate the risk of developing Wernicke’s encephalopathy or Korsakoff’s syndrome.

Intramuscular Pabrinex (1pair once daily for first 3 days) and oral thiamine should be given to all patients undergoing treatment for alcohol withdrawal.

Thiamine should be prescribed as 50mg four times a day, due to absorption saturation giving large doses less often will result in poorer absorption.

Thiamine should be continued indefinitely for those with a history of significant alcohol abuse and in individuals who continue to engage in problem drinking (chronic alcohol reduces thiamine absorption and these individuals are particularly at risk of developing alcohol-related brain damage).

To help with long term adherence to thiamine:

  • Underline the importance of therapy
  • Encourage individuals to take thiamine as often as they remember e.g. take with meals
  • Where there is evidence of poor dietary intake, treatment with a multivitamin preparation containing trace elements (e.g. Forceval) should also be considered
Monitoring

The patient’s blood pressure, pulse and temperature should be monitored at 4 hourly intervals throughout treatment with close observation for over sedation.

The patient should be medically reviewed as necessary during the course of treatment.

Editorial Information

Last reviewed: 28 June 2019

Next review: 01 September 2020

Author(s): Mental health service

Version: 1

Approved By: PMG-MH

Reviewer Name(s): Andrew Walker, Suzanne Burke