Alcohol withdrawal
Chloridazepoxide is the benzodiazepine of choice to control symtoms of acute alcohol withdrawal, such as agitation, tremor, anxiety, autonomic overactivity and seizures. The drug prevents an established alcohol withdrawal syndrome progressing further to the pre-delirium tremens or delirium tremens (DT's) state.
All patients suspected of going into acute alcohol withdrawal should have the following investigations:
- U&E's
- Mg & PO4
- LFT's
- blood glucose
- FBC
- clotting screen
- folate/B12
Symptoms should be assessed immediately using the alcohol withdrawal assessment scoring guidelines, (CIWA-Ar). This should be repeated every 2-4 hours as appropriate.
| If score >35 |
Contact ITU |
| If score >15 |
Treat with scheduled chlordiazepoxide dosing regime to be written on drug chart as suggested |
| If score 8-14 |
Treat with as required chlordiazepoxide 20-30mg and monitor 2 hourly for day 0-2 and 4 hourly for days 3-4 |
| If score <8 |
Monitor 4 hourly but not for treatment |
Chlordiazepoxide reducing regime
| Time |
Day 1
(mg) |
Day 2 |
Day 3 |
Day 4 |
| 08:00 |
30 |
20 |
10 |
10 |
| 12:00 |
30 |
20 |
10 |
|
| 16:00 |
30 |
20 |
10 |
|
| 20:00 |
30 |
30 |
20 |
10 |
Chlordiazepoxide has an abuse and dependence potential - a maximum of 14 days treatment is advised.
This regime is intended for use in hospital only. Chlordiazepoxide is not supplied on discharge and must not be prescribed if the patient is likely to continue drinking alcohol.
Vitamin B supplements may also be required - see the full alcohol withdrawal management protocol (link above).
March 2020: Benzodiazepines and opioids: reminder of the risk of potentially fatal respiratory depression
