Novel Algorithms for the Prophylaxis and Management of Alcohol Withdrawal Syndromes–Beyond Benzodiazepines
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Fig. 1
Summary of neurotransmitter changes associated with AWSs. AWS, alcohol withdrawal syndrome; AWSz, alcohol withdrawal seizures; CRF, corticotropin-releasing factor; DA, dopamine; DT, delirium tremens; GABA, gamma-aminobutyric acid; GLU, glutamate; Mg, magnesium; NA, noradrenaline or norepinephrine; NMDA, N-methyl-D-aspartate receptor.
Fig. 2
Timing of alcohol withdrawal syndromes (AWS).
Fig. 3
Benzodiazepine-sparing alcohol withdrawal prophylaxis and treatment protocol. AWSS, Alcohol Withdrawal Syndrome Scale; BAC, blood alcohol concentration; BZDP, benzodiazepine; CIWA-Ar, Clinical Institute Withdrawal Assessment for Alcohol; PAWSS, Prediction of Alcohol Withdrawal Severity Scale.
Fig. 4
PAWSS.
Benzodiazepine (BZDP) agents are the standard for the prophylaxis and treatment of all phases of alcohol withdrawal syndrome. However, BZDPs have their drawbacks: cognitive impairment, significant neurologic and medical side effects. There are data suggesting that the alcohol recidivism rate and abuse potential is higher for BZDPs treated patients, compared to alternatives. Clinical and research data demonstrate the efficacy and safety of various pharmacologic alternatives to benzodiazepines for the prevention and management of AWS. This article examines the available published evidence regarding the use of non-BZDP agents compared with conventional treatment modalities. The author’s BZDP-sparing protocol is highlighted.
Keywords:
Alcohol withdrawal, Withdrawal prophylaxis, Benzodiazepines, Anticonvulsant agents, Alpha-2 agonists, Delirium tremensTo access this article, please choose from the options below
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