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| =Background=
| | #REDIRECT [[Ethanol withdrawal]] |
| *Consider discharge [[EBQ:Outpatient use of benzodiazepines for the treatment of acute alcohol withdrawl|with 3 day course of benzodiazepines if patients are attempting to quit alcohol]]
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| *Possible exclusions for outpatient treatment<ref>Myrick et al. A DOUBLE BLIND TRIAL OF GABAPENTIN VS. LORAZEPAM IN THE TREATMENT OF ALCOHOL WITHDRAWAL. Alcohol Clin Exp Res. 2009 Sep; 33(9): 1582–1588. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769515/</ref>:
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| **Substance use disorders except alcohol, nicotine, or cannabis
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| **Major Axis I psych disorder
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| **Medication hx of benzodiazepines, BBs, CCBs, antipsychotics
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| **Hx of head injury, epilepsy, medical instability, ECG abnormality, grossly abnormal lab value
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| ==Management==
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| ===[[Chlordiazepoxide]]===
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| '''Generally for outpatient treatment of mild cases and as a taper'''
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| *25-50mg of chlordiazepoxide is equivalent to 10mg of diazepam
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| *50mg of chlordiazepoxide every 8 hours for two days, thel decrease to 25mg every 8 hours for another two days followed by 25mg PRN as needed.
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| ===Anticonvulsants===
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| *[[Gabapentin]] 400mg PO TID<ref>Leung JG, Hall-Flavin D, Nelson S, et al. The role of gabapentin in the management of alcohol withdrawal and dependence. Ann Pharmacother. 2015; 49(8):897-906.</ref>
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| **Some protocols call for higher dosing - 600 or 800mg x1
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| *Similar efficacy to lorazepam in decreasing craving and anxiety<ref>Myrick, H et al. A double-blind trial of gabapentin versus lorazepam in the treatment of alcohol withdrawal. Alcohol Clin Exp Res. 2009 Sep;33(9):1582-8. PMID: 19485969</ref>
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| *Example regimens (please use discretion and balance risk/benefits with your own clinical judgment)
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| ====Example outpatient [[lorazepam]] taper====
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| *2 mg tid x3 days
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| *2 mg bid on day 4
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| *2 mg once on day 5
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| ====Example outpatient [[gabapentin]] taper====
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| ''Similar in efficacy to lorazepam according to one RCT<ref>Myrick et al. A DOUBLE BLIND TRIAL OF GABAPENTIN VS. LORAZEPAM IN THE TREATMENT OF ALCOHOL WITHDRAWAL. Alcohol Clin Exp Res. 2009 Sep; 33(9): 1582–1588. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769515/</ref>''
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| *400 mg tid x3 days
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| *300 mg bid on day 4
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| *300 mg once on day 5
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| ==See Also==
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| *[[Beer Potomania Syndrome]]
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| *[[Alcohol (ETOH) Intoxication]]
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| *[[Alcoholic ketoacidosis]]
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| *[[Alcohol withdrawal]]
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| *[[Alcohol withdrawal: Inpatient management]]
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| *[[Alcohol withdrawal: Outpatient management]]
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| *[[Alcohol withdrawal seizures]]
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| *[[Altered mental status]]
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| *[[Delerium tremens]]
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| *[[EBQ:Outpatient use of benzodiazepines for the treatment of acute alcohol withdrawal]]
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| *[[Sedative/Hypnotic]]
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| *[[Wernicke-Korsakoff Syndrome]]
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| ==External Links==
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| *[http://www.mdcalc.com/ciwa-ar-for-alcohol-withdrawal/#about-calculator MDCalc - CIWA-AR Calculator]
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| ==References==
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| <references/>
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| [[Category:Psych]][[Category:Tox]]
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