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)
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.
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
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.
Use of the information and data contained within this site or these pages is at your sole risk.
If you rely on the information on this site you are responsible for ensuring by independent verification its accuracy, currency or completeness.
This site includes links to other websites operated by community, business and government.
These linked websites will have their own terms and conditions of use and you should familiarise yourself with these.
All linked websites are linked 'as is' and the Government of South Australia:
does not sponsor, endorse or necessarily approve of any material on websites linked from or to this Site;
does not make any warranties or representations regarding the quality, accuracy, merchantability or fitness for purpose of any material on websites linked from or to this Site;
does not make any warranties or representations that material on other websites to which this site is linked does not infringe the intellectual property rights of any person anywhere in the world; and
does not authorise the infringement of any intellectual property rights contained in material in other websites by linking this site to those other websites.
If you use automatic language translation services in connection with this site you do so at your own risk.
The information and data on this site is subject to change without notice. The Government of South Australia may revise this disclaimer at any time by updating this posting.
The Government of South Australia, its agents, instrumentalities, officers and employees:
make no representations, express or implied, as to the accuracy of the information and data contained on this site
make no representations, express or implied, as to the accuracy or usefulness of any translation of the information on this site or any linked website into another language
make no representations as to the availability of the site and the availability of websites linked from or to the site
accept no liability however arising for any loss resulting from the use of the site and any information and data or reliance placed on it (including translated information and data)
make no representations, either expressed or implied, as to the suitability of the said information and data for any particular purpose
accepts no liability for any interference with or damage to a user's computer, software or data occurring in connection with or relating to this Site or its use or any website linked to this site
do not represent or warrant that applications or payments initiated through this site will in fact be received or made to the intended recipient. Users are advised to confirm the application or payment by other means.