NCLEX Review Guide: Psychotherapeutic Medications - Alcohol Withdrawal Treatment

Benzodiazepines - First-Line Treatment

• Chlordiazepoxide (Librium) is the gold standard for alcohol withdrawal, providing long-acting sedation and seizure prevention. The typical dosing is 25-100mg every 6 hours, tapered gradually over 5-7 days.
• Lorazepam (Ativan) is preferred in patients with liver disease due to its shorter half-life and lack of active metabolites. Dosing ranges from 1-4mg every 6-8 hours based on withdrawal severity.
• Diazepam (Valium) provides rapid onset and long duration, making it effective for severe withdrawal symptoms. Initial doses of 10-20mg every 6 hours help prevent delirium tremens.

Adjunct Medications

• Thiamine (Vitamin B1) 100mg IM/IV daily prevents Wernicke-Korsakoff syndrome in chronic alcoholics with nutritional deficiencies. Always give before glucose to prevent precipitating encephalopathy.
• Folic acid and multivitamins address common nutritional deficiencies seen in chronic alcohol use disorder. Folic acid 1mg daily helps prevent megaloblastic anemia.
• Magnesium sulfate 1-2g IV helps control seizures and muscle cramps associated with withdrawal. Low magnesium levels are common in alcoholics.

Alternative Medications

• Carbamazepine (Tegretol) 200mg BID can be used when benzodiazepines are contraindicated, providing anticonvulsant effects. Monitor CBC for blood dyscrasias and liver function tests.
• Gabapentin (Neurontin) 300-600mg TID helps with mild to moderate withdrawal symptoms and reduces cravings. It's particularly useful for outpatient detoxification.
• Clonidine 0.1-0.2mg every 6 hours addresses autonomic hyperactivity symptoms like hypertension and tachycardia. Monitor blood pressure closely to prevent hypotension.

CIWA-Ar Scale Usage

• The Clinical Institute Withdrawal Assessment for Alcohol-Revised scores 0-67 points across 10 symptoms. Scores 8-15 indicate mild withdrawal, 16-20 moderate, and >20 severe withdrawal requiring immediate intervention.
• Assess every 4-8 hours initially, then every 8 hours as symptoms stabilize. Key areas include tremor, sweating, anxiety, agitation, tactile/auditory/visual disturbances, headache, and orientation.

1. Remember the "3 L's" - Librium (chlordiazepoxide) for standard cases, Lorazepam for liver disease, and Long-acting for severe cases
2. CIWA scores: <8 = observe, 8-15 = mild (PRN meds), >15 = scheduled dosing
3. Always give thiamine BEFORE glucose to prevent Wernicke encephalopathy
4. Benzodiazepine withdrawal can be life-threatening - never stop abruptly