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 Alcohol Withdrawal Assessment score <8 CIWA-Ar (PDF 45KB)

Observation/monitoring/safety

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.

Medications

Diazepam

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.

Thiamine

Thiamine 100mg PO eight hourly.
[Consider IV or IM thiamine if person is malnourished or has decompensated liver disease. These individuals should be managed in an inpatient setting anyway]

It is recommended that oral thiamine and multivitamins be continued for the first four weeks of abstinence.

If drinking resumes then continue the thiamine and multivitamins.

Symptomatic medication

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

Alcohol and Drug Information Service (ADIS) - 1300 131 340

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 8:30 am to 10:00 pm. Telephone: 1300 131 340

Drug and Alcohol Clinical Advisory Service (DACAS)

DACAS provides a telephone and email service for South Australian health professionals seeking clinical information and clarification around clinical procedures, guidelines and evidence-based practice.

Telephone: (08) 7087 1742 - 24 hours 7 days/week including public holidays or e-mail your enquiry to: HealthDACASEnquiries@sa.gov.au.

This service does not provide proxy medical cover and cannot assume responsibility for direct patient care.