Alcohol and Benzodiazepine Withdrawal

The thing to remember with both alcohol and benzodiazepine withdrawal is that THEY CAN KILL YOU!

What to watch out for

Withdrawal seizures and alcoholic hallucinosis (hallucinations that develop within 12 – 24 h and resolve within 24 – 48 h)

Delirium Tremens (DTs): hallucinations, disorientation, tachycardia, hypertension, fever, agitation, and diaphoresis. Symptoms can persist for up to 7d

Wernicke’s Encephalopathy: Happens in hours to days, it has a classic triad

  1. Encephalopathy: profound disorientation, indifference and inattentiveness
  2. Oculomotor dysfunction: nystagmus, lateral rectus palsy, conjugate gaze palsies (affecting the CN III, VI and VIII nuclei)
  3. Gait ataxia: affecting the vermis of the cerebellum

How it works

Since alcohol and benzodiazepines both work on the GABA receptor (potentiating the effect of GABA by increasing the frequency of channel opening) they are cross-reactive. This means that you can treat alcohol withdrawal with a tapering dose of benzos (and you can treat benzo withdrawal also with a tapering dose of more benzos).

The thing to watch out for with someone who has chronically used benzodiazepines and has suddenly stopped is that the onset of symptoms will depend on the half-life of that particular drug.

  • Alprazolam (Xanax): 10 – 20 h
  • Lorazepam (Ativan): 10 – 25 h
  • Clonazepam (Rivotril): 20 – 50 h
  • Diazepam (Valium): 30 – 200 h

To minimize benzodiazepine withdrawal symptoms if someone has extended use (>3 months): taper by 1-20% over 6 or more weeks and/or switch to longer-acting agents.

 

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