Alcohol withdrawal syndrome drug of choice

Generally, alcoholics have alcohol withdrawal syndrome, which is a disease that causes physical reactions. It occurs after long-term alcoholism and sudden alcohol withdrawal. It usually manifests as anxiety, irritability, pain and other emotional changes. However, this disease can be treated, including drug therapy. So what is the first choice drug for alcohol withdrawal syndrome?

Alcohol withdrawal syndrome is a group of very painful physiological and psychological symptoms that occur after long-term and heavy drinking. If we stop drinking or reduce the amount of drinking, we will experience limb tremors, sweating, palpitations, increased blood pressure, increased heart rate, irritability, temper tantrums, and convulsions.

First, cut off the source of alcohol, and control the progress of quitting drinking according to the degree of alcohol intoxication and the severity of withdrawal symptoms. For mild cases, you can stop drinking once and for all, and for severe cases, you can give tranquilizers based on the principle of cross-tolerance to relieve alcohol dependence symptoms. Or use the tapering method to gradually quit drinking to avoid severe withdrawal symptoms that endanger your life. Especially in the first week of quitting drinking, vital signs and consciousness status should be closely observed and monitored to prevent accidents.

Benzodiazepines: They are the first choice for the treatment of alcohol withdrawal syndrome. Their advantages are: (1) cross-tolerance with alcohol (2) safe use (3) anti-epileptic effects (4) acting on multiple receptors that cause withdrawal symptoms (5) anti-anxiety (6) treatment of insomnia. Long-acting benzodiazepines such as diazepam (Valium) and clonazepam are the best choices.

Disadvantages: prone to drug accumulation, liver damage, muscle weakness and ataxia. Patients with more severe liver damage can choose BDZs with faster metabolism and short half-life (such as midazolam, temazepam, triazolam). It is recommended to be treated in the ICU.

For ward use. Regarding dosage, generally, when mild sedation occurs, this is the indication for stopping the dosage.

Due to the addictive nature of alcoholics, benzodiazepines should be gradually discontinued after withdrawal symptoms disappear to avoid benzodiazepine dependence.

Vitamin and folic acid supplementation: Alcoholics often suffer from vitamin B1 and folic acid deficiency due to their long-term small food intake and alcohol inhibiting the absorption of vitamins in the small intestine. Vitamin B1 deficiency can develop into Wernicke's encephalopathy, an irreversible dementia. The body's reserves of vitamin B1 are very limited, so sufficient vitamin B1 should be given at the first stage of alcohol abstinence treatment to prevent vitamin B1 depletion and the induction of Wernicke's encephalopathy. For patients with peripheral neuritis, the duration of vitamin B1 supplementation should be extended to 6 to 12 months. Alcoholic patients have poor absorption of vitamins due to gastrointestinal dysfunction, so large oral doses are required and injection treatment is required when necessary.

Correct electrolyte imbalance: Alcoholics often have deficiencies in electrolytes such as magnesium, phosphorus, potassium and sodium, which can have serious consequences. The occurrence of epilepsy and delirium may be related to magnesium deficiency, and magnesium supplementation can help patients reduce the severity of withdrawal symptoms. Blood potassium deficiency can cause heart dysfunction, so timely replenishment of electrolytes is very important.