Alcohol detoxification
Encyclopedia
Alcohol detoxification, or detox, for individuals with alcohol dependence
, is the abrupt cessation of alcohol intake coupled with the substitution of alcohol with cross-tolerant
drugs that have similar effects in order to prevent alcohol withdrawal. As such, the term "detoxification" is somewhat of a misnomer since the process does not in any way involve the removal of toxic substances from the body. Detoxification may or may not be necessary depending upon an individual's age, medical status, and history of alcohol intake. For example, a young man who binge drinks and seeks treatment one week after his last use of alcohol may not require detoxification before beginning treatment for alcoholism. Benzodiazepines are the most common family of drugs used for this, followed by barbiturates.
(Librium), diazepam
(Valium), lorazepam
(Ativan) or oxazepam
(Serax) are the most commonly used drugs used to reduce alcohol withdrawal symptoms. There are several treatment patterns in which it is used.
Dosing of the benzodiazepines can be guided by the CIWA
scale. The scale is available online.
Regarding the choice of benzodiazepine:
.
Various vitamins, especially from the B group, are often used during withdrawal treatment.
Sodium oxybate is the sodium salt of gamma-hydroxybutyric acid
(GHB). It is used for both acute alcohol withdrawal and medium to long-term detoxification. This drug enhances GABA neurotransmission and reduces glutamate levels. It is used in Italy
in small amounts under the trade name Alcover
.
Baclofen
has been shown in animal studies and in small human studies to enhance detoxification. This drug acts as a GABA B receptor agonist and this may be beneficial.
Alcohol dependence
Alcohol dependence, as described in the DSM-IV, is a psychiatric diagnosis describing an entity in which an individual uses alcohol despite significant areas of dysfunction, evidence of physical dependence, and/or related hardship.-Definition and diagnosis:According to the DSM-IV criteria for...
, is the abrupt cessation of alcohol intake coupled with the substitution of alcohol with cross-tolerant
Cross-tolerance
Cross-tolerance refers to a pharmacological phenomenon, in which a patient being treated with a drug exhibits a physiological resistance to that medication as a result of tolerance to a pharmacologically similar drug. In other words, there is a decrease in response to one drug due to exposure to...
drugs that have similar effects in order to prevent alcohol withdrawal. As such, the term "detoxification" is somewhat of a misnomer since the process does not in any way involve the removal of toxic substances from the body. Detoxification may or may not be necessary depending upon an individual's age, medical status, and history of alcohol intake. For example, a young man who binge drinks and seeks treatment one week after his last use of alcohol may not require detoxification before beginning treatment for alcoholism. Benzodiazepines are the most common family of drugs used for this, followed by barbiturates.
Benzodiazepines
Benzodiazepines such as chlordiazepoxideChlordiazepoxide
Chlordiazepoxide, is a sedative/hypnotic drug and benzodiazepine. It is marketed under the trade names Angirex, Klopoxid, Librax , Libritabs, Librium, Mesural, Multum, Novapam, Risolid, Silibrin, Sonimen and Tropium.Chlordiazepoxide was the first benzodiazepine to be synthesised and...
(Librium), diazepam
Diazepam
Diazepam , first marketed as Valium by Hoffmann-La Roche is a benzodiazepine drug. Diazepam is also marketed in Australia as Antenex. It is commonly used for treating anxiety, insomnia, seizures including status epilepticus, muscle spasms , restless legs syndrome, alcohol withdrawal,...
(Valium), lorazepam
Lorazepam
Lorazepam is a high-potency short-to-intermediate-acting 3-hydroxy benzodiazepine drug that has all five intrinsic benzodiazepine effects: anxiolytic, amnesic, sedative/hypnotic, anticonvulsant, antiemetic and muscle relaxant...
(Ativan) or oxazepam
Oxazepam
Oxazepam , is a drug which is a short to intermediate acting 3-hydroxy benzodiazepine derivative...
(Serax) are the most commonly used drugs used to reduce alcohol withdrawal symptoms. There are several treatment patterns in which it is used.
- The first option takes into consideration the varying degrees of tolerance. In it, a standard dose of the benzodiazepine is given every half hour until light sedation is reached. Once a baseline dose is determined, the medication is tapered over the ensuing 3–10 days.
- Another option is to give a standard dose of benzodiazepine based on history and adjust based on withdrawal phenomenon.
- A third option is to defer treatment until symptoms occur. This method should not be used in patients with prior, alcohol-related seizures. This has been effective in randomized controlled trials. A non-randomized, before and after, observational study found that symptom triggered therapy was advantageous.
Dosing of the benzodiazepines can be guided by the CIWA
Ciwa
The CIWA is a common measure used in North American hospitals to assess and treat Alcohol withdrawal syndrome and for Alcohol detoxification. This clinical tool assesses 10 common withdrawal signs...
scale. The scale is available online.
Regarding the choice of benzodiazepine:
- Chlordiazepoxide (Librium) is the benzodiazepine of choice in uncomplicated alcohol withdrawal due to its long half-life.
- Lorazepam or diazepam is available as an injection for patients who cannot safely take medications by mouth.
- Lorazepam and oxazepam are indicated in patients with impaired liver function because they are metabolised outside of the liver.
Sympatholytics
Randomized controlled trials have found benefit from atenolol and clonidineClonidine
Clonidine is a sympatholytic medication used to treat medical conditions, such as high blood pressure, some pain conditions, ADHD and anxiety/panic disorder...
.
Other drugs
Some hospitals administer alcohol to prevent alcohol withdrawal although there are potential problems with this practice.Various vitamins, especially from the B group, are often used during withdrawal treatment.
Sodium oxybate is the sodium salt of gamma-hydroxybutyric acid
Gamma-Hydroxybutyric acid
γ-Hydroxybutyric acid , also known as 4-hydroxybutanoic acid and sodium oxybate when used for medicinal purposes, is a naturally occurring substance found in the central nervous system, wine, beef, small citrus fruits, and almost all animals in small amounts. It is also categorized as an illegal...
(GHB). It is used for both acute alcohol withdrawal and medium to long-term detoxification. This drug enhances GABA neurotransmission and reduces glutamate levels. It is used in Italy
Italy
Italy , officially the Italian Republic languages]] under the European Charter for Regional or Minority Languages. In each of these, Italy's official name is as follows:;;;;;;;;), is a unitary parliamentary republic in South-Central Europe. To the north it borders France, Switzerland, Austria and...
in small amounts under the trade name Alcover
Alcover
Alcover is a municipality in the comarca of Alt Camp, Tarragona, Catalonia, Spain.The Prades Mountains are located in the vicinity of this municipality....
.
Baclofen
Baclofen
Baclofen is a derivative of gamma-aminobutyric acid . It is primarily used to treat spasticity and is under investigation for the treatment of alcoholism....
has been shown in animal studies and in small human studies to enhance detoxification. This drug acts as a GABA B receptor agonist and this may be beneficial.