Ambulatory/home setting management of alcohol withdrawal
Management of alcohol withdrawal at home could be considered if the person:
- does not have a history of withdrawal seizures
- does not have a history of complicated withdrawal
- has stable accommodation
- has an appropriate support person to monitor them and assist with medication administration
- is medically and psychiatrically stable. (If the person has been an inpatient then they need to be medically and/or psychiatrically reviewed and cleared as low risk of complications if managed in a home setting).
- is experiencing mild withdrawal symptoms after 48 hours ( <8 CIWA-Ar (PDF 45KB)
NOTE 1 the person should be reviewed either by a doctor or a nurse once per day for at least five days. The severity of their withdrawal should be monitored using the CIWA-Ar (PDF 45KB).
NOTE 2 a contingency plan should be developed in case of deterioration in the person’s condition. This should include who to contact any time of day or night as well as what to do in emergencies.
Worsening withdrawal at 3 to 10 days after the person’s last drink may indicate onset of delirium tremens (a medical emergency). Urgent transfer to hospital is recommended – carers should be urged to call an ambulance on 000.
NOTE 3 patients should be advised not to drive during withdrawal, due to effects of the withdrawal, as well as the benzodiazepines.
Fixed dosing regime with diazepam (start with QID dosing reducing to TDS, BD then OD) - total daily doses below:
- Day 1 and 2: 40mg over each day
- Day 3 and 4: 25mg over each day Day 5 and 6: 10mg over each day
Diazepam needs to be time limited – ie no longer than one week.
At least one dose of IM thiamine 100mg should be administered. Preferably this should be daily for three days.
It is recommended that oral thiamine and multivitamins continue to be administered at home.
Consider offering simple analgesia, antinauseants and anti-diarrhoeals:
- paracetamol up to 1000mg qid,
- metoclopramide 10mg tds,
- loperamide 2mg up to qid
NON-COMPLETION OF WITHDRAWAL
If the person decides to discontinue the withdrawal, and resumes drinking then the benzodiazepines should be ceased.
Further information and advice
ADIS is a confidential telephone information, counselling, and referral service for people dealing with their own or another’s alcohol or drug problem. ADIS operates seven days per week 830AM to 10PM.
Drug and Alcohol Clinical Advisory Service (DACAS)
DACAS provides general practitioners and other health professionals direct telephone access to a specialist drug and alcohol medical officer 24/7.
Telephone: (08) 7087 1742.