Diazepam (Valium®) is recommended due to its efficacy profile, wide therapeutic window and ‘self-tapering’ effect due to its long half life. Other benzodiazepines can also be considered, including clonazepam, lorazepam and oxazepam. In the case of intolerance to benzodiazepines, physicians may wish to consider using a different class of medications (e.g., anticonvulsants). It is recommended that physicians with less experience with diazepam follow the rigid schedule. Physicians with experience using diazepam for alcohol withdrawal can consider front loading.
Three medication protocols are provided.
* Pulse rate > 100 per minute, diastolic blood pressure > 90 mm Hg or signs of withdrawal.
** Frequently, very little additional medication is necessary after initial loading. Note: Benzodiazepines should be discontinued after withdrawal symptoms resolved (5–7 days).
1. Myrick, H., & Anton, R.F. (1998). Treatment of alcohol withdrawal. Alcohol Health and Research World, 22(1).
2. Amato, L., Ninozzi, S., Vecchi, S., et. al., Benzodiazepines for alcohol withdrawal. Cochrane Database of Systematic Reviews, 2010(3).
3. Bayard, M., Mcintyre, J., Hill, K.R., et al. (2004). Alcohol withdrawal syndrome. American Family Physician, 69(6), 1443–1450.