Patients successfully treated for AWS should be offered referral to a long-term treatment program to maintain abstinence and adjunctive use of an FDA-approved pharmacotherapy (i.e., acamprosate, naltrexone, and disulfiram ). Gabapentin, carbamazepine, and valproate (Depacon) may be prescribed as adjuncts to benzodiazepines if symptoms persist despite adequate benzodiazepine use. 20, 21Ĭlinical practice guideline and ASAM meta-analysis 8, 18, 19ĪSAM guideline recommendation, randomized controlled trial, and reviewīenzodiazepines are the preferred medication for treating moderate AWS. 8Ĭarbamazepine (Tegretol) and gabapentin (Neurontin) are appropriate options for treating mild AWS. Patients with mild or moderate AWS can be treated safely in the outpatient setting. Preventive Services Task Force recommendation Primary care physicians should offer to initiate long-term treatment for alcohol use disorder, including pharmacotherapy, in addition to withdrawal management.Īdults should be screened for unhealthy alcohol use and counseled, if appropriate. Physicians should monitor outpatients with alcohol withdrawal syndrome daily for up to five days after their last drink to verify symptom improvement and to evaluate the need for additional treatment. Benzodiazepines are first-line therapy for moderate to severe symptoms, with carbamazepine and gabapentin as potential adjunctive or alternative therapies. Mild symptoms can be treated with carbamazepine or gabapentin. Ambulatory withdrawal treatment should include supportive care and pharmacotherapy as appropriate. Patients with mild to moderate withdrawal symptoms without additional risk factors for developing severe or complicated withdrawal should be treated as outpatients when possible. Two commonly used tools to assess withdrawal symptoms are the Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised, and the Short Alcohol Withdrawal Scale. The three-question Alcohol Use Disorders Identification Test–Consumption and the Single Alcohol Screening Question instrument have the best accuracy for assessing unhealthy alcohol use in adults 18 years and older. ![]() If untreated or inadequately treated, withdrawal can progress to generalized tonic-clonic seizures, delirium tremens, and death. The syndrome is due to overactivity of the central and autonomic nervous systems, leading to tremors, insomnia, nausea and vomiting, hallucinations, anxiety, and agitation. Approximately one-half of patients with alcohol use disorder who abruptly stop or reduce their alcohol use will develop signs or symptoms of alcohol withdrawal syndrome.
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