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Drugs & Aging

, Volume 14, Issue 6, pp 409–425 | Cite as

Managing Alcohol Withdrawal in the Elderly

  • Kevin L. Kraemer
  • Joseph Conigliaro
  • Richard Saitz
Disease Management

Abstract

The alcohol withdrawal syndrome is common in elderly individuals who are alcohol dependent and who decrease or stop their alcohol intake. While there have been few clinical studies to directly support or refute the hypothesis that withdrawal symptom severity, delirium and seizures increase with advancing age, several observational studies suggest that adverse functional and cognitive complications during alcohol withdrawal do occur more frequently in elderly patients. Most elderly patients with alcohol withdrawal symptoms should be considered for admission to an inpatient setting for supportive care and management. However, elderly patients with adequate social support and without significant withdrawal symptoms at presentation, comorbid illness or past history of complicated withdrawal may be suitable for outpatient management.

Although over 100 drugs have been described for alcohol withdrawal treatment, there have been no studies assessing the efficacy of these drugs specifically in elderly patients. Studies in younger patients support benzodiazepines as the most efficacious therapy for reducing withdrawal symptoms and the incidence of delirium and seizure. While short-acting benzodiazepines, such as oxazepam and lorazepam, may be appropriate for elderly patients given the risk for excessive sedation from long-acting benzodiazepines, they may be less effective in preventing seizures and more prone to produce discontinuation symptoms if not tapered properly. To ensure appropriate benzodiazepine treatment, dose and frequency should be individualised with frequent monitoring, and based on validated alcohol withdrawal severity measures. Selected patients who have a history of severe or complicated withdrawal symptoms may benefit from a fixed schedule of benzodiazepine provided that medication is held for sedation. β-Blockers, clonidine, carbamazepine and haloperidol may be used as adjunctive agents to treat symptoms not controlled by benzodiazepines. Lastly, the age of the patient should not deter clinicians from helping the patient achieve successful alcohol treatment and rehabilitation.

Keywords

Adis International Limited Alcohol Withdrawal Oxazepam Alcohol Withdrawal Syndrome Chlormethiazole 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Adis International Limited 1999

Authors and Affiliations

  • Kevin L. Kraemer
    • 1
  • Joseph Conigliaro
    • 2
  • Richard Saitz
    • 3
  1. 1.Center for Research on Healthcare, Division of General Internal MedicineUniversity of Pittsburgh School of MedicinePittsburghUSA
  2. 2.Section of General MedicineVA Pittsburgh Healthcare SystemPittsburghUSA
  3. 3.Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical CenterBoston University School of MedicineBostonUSA

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