Author: John Carter

Does Clonidine Help with Alcohol Withdrawal?

Valproic acid (400–500 mg tid) is able to produce a dose-dependent improvement of AWS symptoms [6, 81], with a reduced incidence of seizures and a protection toward the worsening of AWS severity (anti-kindling effect). These characteristics make valproic acid an interesting and promising drug in the outpatient management of mild-to-moderate forms of AWS [82]. The most commonly observed side-effects were gastrointestinal distress, tremor and sedation [22]. The possible increase of liver enzymes (transaminases) could limit its use in AD patients with liver impairment. BZDs administration represents the cornerstone for the management of any grade of AWS, including seizures and DT.

People who are not dependent on drugs will not experience withdrawal and hence do not need WM. Refer to the patient’s assessment to determine if he or she is dependent and requires WM. While not as common as opioid or amphetamine addiction, clonidine addiction may occur. As a drug with fewer restrictions than opioids, clonidine is not as difficult to obtain and therefore more available in non-prescription settings. He worked for many years in mental health and substance abuse facilities in Florida, as well as in home health (medical and psychiatric), and took care of people with medical and addictions problems at The Johns Hopkins Hospital in Baltimore. He has a nursing and business/technology degrees from The Johns Hopkins University.

Assessing patients in this way allows clinicians to provide counseling to those who engage in risky drinking patterns. Patients suffering from mild to moderate AWS can be managed as outpatients while more severe forms should be monitored and treated in an inpatient setting. The availability of an Alcohol Addiction Unit is of help in the clinical evaluation, management, and treatment of AWS patients, with a reduction in hospitalization costs. Patients can be managed principally as outpatients and transferred to the inpatient unit only when the clinical situation requires [45]. The mild-moderate form of AWS is often self-managed by patients or disappears within 2–7 days from the last drink [5, 7], while the more severe AWS requires medical treatment [4, 5].

ALCOHOL WITHDRAWAL SYNDROME

In patients affected by severe DT requiring mechanical ventilation, the combination of benzodiazepines and barbiturates produces both a decrease in the need of mechanical ventilation and a trend towards a decrease in ICU length of stay [70]. With the help of safe medications to reduce your symptoms, including drugs like diazepam and clonidine, mild to moderate AWS is manageable for many clients on an outpatient basis. If you have struggled with remaining off alcohol after rehab or if your symptoms prove to be more severe than expected, you always have the option of intensive outpatient treatment, which includes more therapy than a normal outpatient experience.

1. Withdrawal management alone is unlikely to lead to sustained abstinence from benzodiazepines.
2. More recently, an up-regulation of glutamate receptors α-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) and kainate has been described during AWS [19, 20].
3. Different types of benzodiazepines are equally effective in treating AWS, so supply is rarely an issue.
4. The risk of BZD toxicity is high during the early phase of the treatment and the patient requires a strict clinical monitoring to prevent BZD toxicity.
5. After withdrawal is completed, the patient should be engaged in psychosocial interventions such as described in Section 5.

Epidural clonidine used as an adjunct to local anesthetics has three different mechanisms of action. First, the stimulation of alpha-2-receptors in the dorsal horn reduces pain transmission. Secondly, clonidine can cause local vasoconstriction that limits vascular removal of local epidural anesthetics. Lastly, clonidine enhances neuraxial opioids and, in combination with fentanyl, interacts in an additive manner, which can reduce the dose of each component by 60% for postoperative analgesia. By sticking with your prescribed dosage and following your physician’s instructions, you can avoid becoming dependent on clonidine. If you experience symptoms of clonidine withdrawal, seek treatment from a qualified medical professional.

Buprenorphine is the best opioid medication for management of moderate to severe opioid withdrawal. Signs of alcohol withdrawal syndrome may appear just a few hours after a client quits drinking. More severe symptoms start within the first 24 hours of a person’s last drink.

Alcohol Awareness Month

Offer accurate, realistic information about drugs and withdrawal symptoms to help alleviate anxiety and fears. However, more controlled clinical trials are needed to measure the efficacy of nonbenzodiazepines in the treatment of AWS and AUD. Until such time as more data are available to support the use of other agents over the benzodiazepines, they will remain the treatment of choice. While the drug is relatively safe, it is essential to discuss any potential contraindications and adverse effects with the pharmacist. The drug is also known to cause physical and psychological dependence.[13] This, in addition to the drug’s clinical implications, are why an interprofessional team approach is necessary.

AWS usually develops in alcohol-dependent patients within 6–24 hours after the abrupt discontinuation or decrease of alcohol consumption. It is a potentially life-threatening condition whose severity ranges from mild/moderate forms characterized by tremors, nausea, anxiety, and depression, to severe forms characterized by hallucinations, seizures, delirium tremens and coma [6]. Additional doses can be administered if symptoms are not adequately controlled.

The dose of buprenorphine given must be reviewed on daily basis and adjusted based upon how well the symptoms are controlled and the presence of side effects. The greater the amount of opioid used by the patient, the larger the dose of buprenorphine required to control symptoms. Symptoms that are not satisfactorily reduced by buprenorphine can be managed with symptomatic treatment as required (see Table 3).

8. WITHDRAWAL MANAGEMENT FOR CANNABIS DEPENDENCE

In particular, the European Federation of Neurological Societies recommends the use of benzodiazepines for the primary prevention and for the treatment of AWS-related seizures. Although lorazepam has some pharmacological advantages to diazepam, the differences are minor and, because i.v. Other drugs for detoxification should only be considered as add-on treatments (Level A recommendation) [65]. Despite its primary indication as anticonvulsivant drug, phenytoin has been shown to be ineffective in the secondary prevention of alcohol withdrawal seizures in placebo-controlled trials [66]. Article selection was limited toclinical trials (all phases), case series, case reports, and review articles,including only human subjects, published in English language, and in the criticalcare setting.

Treatment of DT requires the use of BZDs as primary drugs, with the possible use of neuroleptics to control psychosis and dysperceptions (see further). The treatment of AWS requires the use of a long-acting drug as a substitutive agent to be gradually tapered off [50] (figure 1). Non-pharmacologic interventions are the first-line approach and, sometimes, the only approach required. They include frequent reassurance, reality orientation, and nursing care [38]. A quiet room without dark shadows, noises, and other excessive stimuli (i.e. bright lights) is recommended [46]. The risk for severe AWS can be assessed by using the LARS (Luebeck Alcohol withdrawal Risk Scale) [41], or the recently proposed PAWSS (Prediction of Alcohol Withdrawal Severity Scale) [42].

While opioids are highly addictive, clonidine tends to be safer over short-term, medically monitored use. As an alpha-2 agonist, clonidine helps relieve pain in clinical settings. For example, the use of clonidine in intensive care, along with local anesthetics, provides pain relief for patients using breathing tubes. It also comes in liquid form for IV applications or as a patch worn on the skin.

AWS is a cause of severe discomfort to patients, symptoms are disabling and patients who experienced withdrawal, often are afraid to stop drinking for fear of developing withdrawal symptoms again. The main goal of the treatment is to minimize the severity of symptoms in order to prevent the more severe manifestations such as seizure, delirium and death and to improve the patient’s quality of life [6, 44]. Moreover an effective treatment of AWS should be followed by efforts in increasing patient motivation to maintain long-term alcohol abstinence and facilitate the entry into a relapse prevention program [6, 44]. Delirium tremens represents the most severe manifestation (4th degree) of AWS, as the result of no treatment or undertreatment of AWS [6], and occurrs approximately in 5% of patients with AWS [6]. Usually it appears 48–72h after the last drink, although it could begin up to 10 days later.

However, in patients with reduced liver metabolism, such as in the elderly or in those with advanced liver disease, the use of short-acting agents may be preferred in order to prevent excessive sedation and respiratory depression [55]. In these cases, oxazepam and lorazepam represent the drugs of choice due to the absence of oxidative metabolism and active metabolites [21, 54, 61] (table 5). Clonidine is a drug doctors typically prescribe to treat high blood pressure. Classified as an antihypertensive, clonidine affects nerve impulses in the brain, helping the blood vessels relax and facilitating better blood flow. Doctors also use clonidine to treat attention deficit hyperactivity disoerder (ADHD). In addition, clonidine may ease symptoms of alcohol withdrawal syndrome (AWS) when used in conjunction with other medications like diazepam.