Identification and Management of Alcohol Withdrawal Syndrome

Abstract

Symptoms of alcohol withdrawal syndrome (AWS) may develop within 6–24 h after the abrupt discontinuation or decrease of alcohol consumption. Symptoms can vary from autonomic hyperactivity and agitation to delirium tremens. The gold-standard treatment for AWS is with benzodiazepines (BZDs). Among the BZDs, different agents (i.e., long-acting or short-acting) and different regimens (front-loading, fixed-dose or symptom-triggered) may be chosen on the basis of patient characteristics. Severe withdrawal could require ICU admission and the use of barbiturates or propofol. Other drugs, such as α2-agonists (clonidine and dexmetedomidine) and β-blockers can be used as adjunctive treatments to control neuroautonomic hyperactivity. Furthermore, neuroleptic agents can help control hallucinations. Finally, other medications for the treatment for AWS have been investigated with promising results. These include carbamazepine, valproate, sodium oxybate, baclofen, gabapentin and topiramate. The usefulness of these agents are discussed.

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Acknowledgments

This study was supported by the Italian Ministry for University, Scientific and Technological Research (MURST) (AM, CDA, AF, GV, MA, FC, AG, GA). LL is a federal employee in the Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, which is supported by the Division of Intramural Clinical and Biological Research of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Intramural Research Program of the National Institute on Drug Abuse (NIDA) (the content of this review is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health). We thank Ms. Caterina Mirijello for her expert revision of the English language.

Conflicts of interest

Prof. Addolorato served as a consultant for Ortho-McNeil Janssen Scientific Affairs, LLC, and D&A Pharma, was paid for his consulting services and received lecture fees and Grants from D&A Pharma, CT Laboratories and Lundbeck.

Dr. Caputo reports personal fees from D&A Pharma and personal fees from CT Pharmaceutical Industries.

Dr. Mirijello, Dr. D’Angelo, Dr. Ferrulli, Dr. Vassallo, Dr. Antonelli, Dr. Leggio and Prof. Gasbarrini report no financial interests or potential conflicts of interest.

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Correspondence to Giovanni Addolorato.

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Mirijello, A., D’Angelo, C., Ferrulli, A. et al. Identification and Management of Alcohol Withdrawal Syndrome. Drugs 75, 353–365 (2015). https://doi.org/10.1007/s40265-015-0358-1

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Keywords

  • Gabapentin
  • Topiramate
  • Baclofen
  • Sodium Oxybate
  • Alcohol Withdrawal Syndrome