Alcohol Withdrawal Syndrome: Outpatient Management

In most cases, mild symptoms may start to develop within hours after the last drink, and if left untreated, can progress and become more severe. Because chronic alcohol use is widespread in society, all healthcare workers, including the nurse and pharmacist, should be familiar with the symptoms of alcohol withdrawal and its management. Nurses monitoring alcoholic patients should be familiar with signs and symptoms of alcohol withdrawal and communicate to the interprofessional team if there are any deviations from normal. For those who develop delirium tremens, monitoring in a quiet room is recommended.

Levetiracetam has also been studied in three randomized controlled trials for the long-term treatment of AUD. Next, in a 42-day randomized, crossover, placebo-controlled trial in 46 non-treatment-seeking moderate-to-heavy drinkers, levetiracetam did not improve treatment outcomes relative to placebo [78]. In fact, a median split into low- and high-level drinkers revealed that levetiracetam increased alcohol consumption in the lower half relative to placebo. Finally, in a multi-site randomized, placebo-controlled trial of levetiracetamin 16 weeks post-detoxification, levetiracetam did not have better efficacy than placebo on the primary outcome measures—the percentage and time to relapse of heavy drinking [79]. These results suggest that levetiracetam likely lacks efficacy in the treatment of alcohol dependence [80].

How Does Alcohol Work in the Brain?

As your body adjusts to life without the medication, you may be given medication and therapy options to help you get through the withdrawal phase as safely as possible. If you seek treatment for an alcohol use disorder, you will likely begin with a medical assessment. If you’re dependent on alcohol, you may need to go through a tapering period with the help of a doctor. People with moderate-to-severe alcohol use disorder often begin with a medical detox program.

Drugs like benzodiazepines are often used to treat alcohol withdrawal, and they can also be used to taper you off alcohol. Medical detox is highly https://ecosoberhouse.com/ intensive inpatient treatment with medically managed services. Alcohol dependence may be treated with various options, including medications.

What Are Seizures?

Adjunctive divalproex did not improve bipolar disorder (both manic and/or depressive) symptoms [65]; however, this study was specifically powered for drinking-related measures. Most patients discontinued participation and, of those that completed therapy, divalproex was not superior to lithium alone on both mood and substance-related outcomes. Next, Myrick et al. [41] compared two doses of gabapentin with lorazepam for outpatient detoxification and followed drinking patterns in the immediate post-detoxification period (again, up to 12 days).

Inpatient and residential treatment can provide additional medical monitoring to ensure your safety and sobriety. Kindling is caused by the chronic use of drugs that cause GABA receptors’ downregulation. Chronic depressant use and withdrawal can cause hypersensitivity in your nervous system. It’s worth noting that opioids share many similarities with depressants, but they don’t work with GABA in the brain as alcohol does. If you’ve gone through opioid withdrawal before, you may need to experience the kindling effects. The main concern over the development of delirium tremens during alcohol withdrawal is the threat of mortality that comes with it.

Alcohol Withdrawal Seizures

Newer agents, such as chlormethiazole, topiramate, gabapentin, and valproate are promising, but validation in controlled clinical trials is necessary. The emerging understanding of the neurobiology of alcohol withdrawal suggests additional treatment approaches. As shown in Table 1, the sodium channel–blocking antiepileptic drugs carbamazepine and phenytoin are weak or ineffective in rodent models of alcohol withdrawal seizures, which corresponds with their lack of effectiveness in many other types of generalized seizures. In line with results from animal studies, there is little evidence that carbamazepine prevents alcohol withdrawal seizures and delirium in humans, although it may be useful to treat alcohol craving (1). Similarly, phenytoin is not effective in protecting against the occurrence of seizures in withdrawing alcoholics (71,72).

However, if you’re experiencing some of these symptoms, it could also mean you are about to experience a potential symptom that is particular to alcohol withdrawal called delirium tremens. However, alcohol, along with other depressants, is among the most dangerous substances during the withdrawal phase, especially if you quit cold turkey. The overstimulating effects of alcohol withdrawal can lead to increased blood pressure, heart palpitations, sleeplessness, fever, hallucinations, panic, and seizures. As the brain begins to react to the sudden lack of alcohol in the system, the symptoms become more intense.

Patients with severe withdrawal symptoms may require escalating doses and intensive care level monitoring. Early consultation with a toxicologist is recommended to assist with aggressive management as these patients may require benzodiazepine doses at a level higher than the practitioner is comfortable with to manage their symptoms. As a response to chronic alcohol misuse or abuse, your body will adapt by tilting your chemical balance toward more excitatory chemicals. When the inhibitory presence of alcohol is discontinued suddenly, your brain chemistry will be more stimulated than normal, causing withdrawal symptoms consistent with overstimulation, like anxiety, tremors, and sleeplessness.

Adequate nutrition must be ensured with care to prevent aspiration in over-sedated patients. Alcohol acts by stimulating receptors in your brain that cause brain activity to be suppressed. Alcohol itself does not normally cause seizures, but during withdrawal, when the suppressive activity of alcohol is removed, your brain will be more susceptible to seizures than it normally would. There are some specific considerations that may affect your risk of seizures when using alcohol. If you are thinking about quitting drinking, talk to your healthcare provider. Medical supervision, behavioral health treatment, and mutual-aid groups can help you through alcohol withdrawal and stay stopped.

Topiramate was administered in a fixed dose of 25 mg every 6 h (100 mg/day), and symptom-triggered diazepam was provided for rescue if study medications failed to suppress acute withdrawal symptoms. Most alcohol withdrawal seizures occur between 12 and 48 hours after a sharp decline in blood alcohol concentrations. Some alcoholics drink to control the tremulousness that sometimes precedes seizures; therefore, the smell of alcohol on the breath does not rule out the diagnosis of alcohol withdrawal seizures. Typically, alcohol withdrawal seizures are why does alcohol withdrawal cause seizures brief, recur within a period of 6 to 12 hours, and are self-limited. If the patient has recovered completely within this period of time and has a clear history of recent alcohol withdrawal and a normal neurological examination then neuroimaging studies are unlikely to disclose a cerebral lesion. In contrast, prolonged or widely separated seizures, focal seizures, prolonged postictal state, or a focally abnormal neurologic examination should prompt a search for correctable structural lesions, metabolic abnormalities, or infection (Table 200-1).

• This is the period in which delirium tremens is most likely to occur, which requires immediate medical attention.
• Intact, adult male rats, with high endogenous androgen levels, have fewer seizures than do either intact juvenile (30 days old) or middle-aged (13 months old) male rats, both of which have lower endogenous androgen levels.
• Furthermore, being in a professional setting offers a structured environment free from triggers and temptations, ensuring a safer and more effective detox journey.
• Also, consider these risk factors for any patient presenting with seizures of unknown etiology.
• In a two-center randomized placebo-controlled trial by Bonnet et al. [39], gabapentin was tested as an adjunctive medication to symptom-triggered clomethiazole for 61 inpatients with alcohol dependence and moderate-to-severe AWS.
• Prior to the seizure, you may also experience an “aura,” consisting of an unusual visual change, smell, taste, or sound caused by abnormal brain activity.
• The overstimulating effects of alcohol withdrawal can lead to increased blood pressure, heart palpitations, sleeplessness, fever, hallucinations, panic, and seizures.