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Review
. 2013 Jul;22(2):100-8.
doi: 10.4103/0972-6748.132914.

Clinical management of alcohol withdrawal: A systematic review

Shivanand Kattimani  1 , Balaji Bharadwaj  1
Affiliations
Review

Clinical management of alcohol withdrawal: A systematic review

Shivanand Kattimani et al. Ind Psychiatry J. 2013 Jul.

Abstract

Alcohol withdrawal is commonly encountered in general hospital settings. It forms a major part of referrals received by a consultation-liaison psychiatrist. This article aims to review the evidence base for appropriate clinical management of the alcohol withdrawal syndrome. We searched Pubmed for articles published in English on pharmacological management of alcohol withdrawal in humans with no limit on the date of publication. Articles not relevant to clinical management were excluded based on the titles and abstract available. Full-text articles were obtained from this list and the cross-references. There were four meta-analyses, 9 systematic reviews, 26 review articles and other type of publications like textbooks. Alcohol withdrawal syndrome is a clinical diagnosis. It may vary in severity. Complicated alcohol withdrawal presents with hallucinations, seizures or delirium tremens. Benzodiazepines have the best evidence base in the treatment of alcohol withdrawal, followed by anticonvulsants. Clinical institutes withdrawal assessment-alcohol revised is useful with pitfalls in patients with medical comorbidities. Evidence favors an approach of symptom-monitored loading for severe withdrawals where an initial dose is guided by risk factors for complicated withdrawals and further dosing may be guided by withdrawal severity. Supportive care and use of vitamins is also discussed.

Keywords: Alcohol withdrawal delirium; alcohol withdrawal seizures; alcoholism; clinical management; drug therapy.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Neurochemistry of alcohol withdrawal
Figure 2
Figure 2
Graph depicting the time course of alcohol withdrawal symptoms (based on clinical information gathered in Table 2; adaptation from Haber et al.[7])
See this image and copyright information in PMC

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