Expert opinion on management of alcohol withdrawal syndrome in India
DOI:
https://doi.org/10.18203/2349-3933.ijam20250385Keywords:
Alcohol dependence, AWS, Delirium tremens, BZDs, AnticonvulsantsAbstract
Alcohol dependence is an escalating and pervasive problem worldwide. Alcohol withdrawal syndrome (AWS) is a distressing condition, occurring due to abrupt discontinuation of alcohol in alcohol dependents. It is a common management problem encountered in general hospital settings. The symptoms of AWS range from mild to severe. Proper diagnosis and choice of an appropriate drug regimen for AWS play a key role in effective management. Severe complicated alcohol withdrawal may present with hallucinations, seizures, or delirium tremens. Benzodiazepines (BZDs), considered as the gold standard, have the largest evidence base as treatment for alcohol withdrawal. Other management strategies include use of essential vitamins (as supportive care), anticonvulsants, barbiturates, adrenergic drugs, and gamma-aminobutyric acid (GABA) agonists. Chlordiazepoxide is an effective long-acting benzodiazepine agent and offers a slight advantage over other BZDs. The present review aims to provide an evidence-based consensus on management algorithm for AWS according to the Indian clinical scenario.
Metrics
References
Girish K, Vikram Reddy K, Pandit LV, Pundarikaksha HP, Vijendra R, Vasundara K, et al. A randomized, open-label, standard controlled, parallel group study of efficacy and safety of baclofen, and chlordiazepoxide in uncomplicated alcohol withdrawal syndrome. Biomed J. 2016;39(1):72-80. DOI: https://doi.org/10.1016/j.bj.2015.09.002
Glantz MD, Bharat C, Degenhardt L, Sampson NA, Scott KM, Lim CCW et al. The epidemiology of alcohol use disorders cross-nationally: Findings from theWorld Mental Health Surveys, Addictive Behaviors. 2018.
Alcohol. World health organization. Available at: https://www.who.int/news-room/fact-sheets/detail/alcohol, Accessed on 10 October 2024.
Jagadeesan S, Patel P. Epidemiology, pattern and prevalence of alcohol consumption in India: need for public health action. Int J Community Med Publ Health. 2021;8(4):2070-6. DOI: https://doi.org/10.18203/2394-6040.ijcmph20211282
Sachdeva A, Choudhary M, Chandra M. Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. J Clin Diagn Res. 2015;9(9):VE01-7. DOI: https://doi.org/10.7860/JCDR/2015/13407.6538
Wolf C, Curry A, Nacht J, Simpson SA. Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives. Emerg Med. 2020;12:53-65. DOI: https://doi.org/10.2147/OAEM.S235288
Muncie HL Jr, Yasinian Y, Oge' L. Outpatient management of alcohol withdrawal syndrome. Am Fam Physician. 2013;88(9):589-95.
Jan MM, Majeed N, Mufti S, Margoob MA. Management of patients with alcohol withdrawal syndrome. The Int J Indian Psychol. 2020;8(1):DIP:18.01.135/20200801.
Jesse S, Bråthen G, Ferrara M, Keindl M, Ben-Menachem E, Tanasescu R, et al. Alcohol withdrawal syndrome: mechanisms, manifestations, and management. Acta Neurol Scand. 2017;135(1):4-16 DOI: https://doi.org/10.1111/ane.12671
Newman RK, Stobart Gallagher MA, Gomez AE. Alcohol Withdrawal. 2021 May 29. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021.
Mirijello A, D'Angelo C, Ferrulli A, Vassallo G, Antonelli M, Caputo F, Leggio L, Gasbarrini A, Addolorato G. Identification and management of alcohol withdrawal syndrome. Drugs. 2015;75(4):353-65. DOI: https://doi.org/10.1007/s40265-015-0358-1
Sinclair JMA, O'Neill A. Update on the management of alcohol use disorders. B J Psych Adv. 2020;26:82-91. DOI: https://doi.org/10.1192/bja.2019.61
Ahwazi HH, Abdijadid S. Chlordiazepoxide. 2020 Nov 22. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2021.
Kumar CN, Andrade C, Murthy P. A randomized, double-blind comparison of lorazepam and chlordiazepoxide in patients with uncomplicated alcohol withdrawal. J Stud Alcohol Drugs. 2009;70(3):467-74. DOI: https://doi.org/10.15288/jsad.2009.70.467
Kattimani S, Bharadwaj B. Clinical management of alcohol withdrawal: A systematic review. Ind Psychiatr J. 2013;22(2):100-8. DOI: https://doi.org/10.4103/0972-6748.132914
Alvanzo A, Kleinschmidt K, Kmiec JA, Kolodner G, Marti GE, et al. The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management. 2020. Available at: https://www.asam.org/docs/default-source/quality-science/the_asam_clinical_practice_guideline_on_alcohol-1.pdf?sfvrsn=ba255c2_2, Accessed on 13 August 2024.
DeVido JJ, Weiss RD. Treatment of the depressed alcoholic patient. Curr Psychiatry Rep. 2012;14(6):610-8. DOI: https://doi.org/10.1007/s11920-012-0314-7
Archibald L, Brunette MF, Wallin DJ, Green AI. Alcohol Use Disorder and Schizophrenia or Schizoaffective-Disorder. Alcohol Res. 2019;40(1):arcr.v40.1.06. DOI: https://doi.org/10.35946/arcr.v40.1.06
Grunze H, Schaefer M, Scherk H, Born C, Preuss UW. Comorbid Bipolar and Alcohol Use Disorder-A Therapeutic Challenge. Front Psychiatry. 2021;12:660432. DOI: https://doi.org/10.3389/fpsyt.2021.660432
Cooney G, Heydtmann M, Smith ID. Baclofen and the Alcohol Withdrawal Syndrome-A Short Review. Front Psychiatry. 2019;9:773. DOI: https://doi.org/10.3389/fpsyt.2018.00773
Downloads
Published
How to Cite
Issue
Section
