1. If your patient fits DSM5 diagnostic criteria for alcohol withdrawal:
PAWSS, Prediction of Alcohol Withdrawal Severity Scale (see mdcalc); SBIRT, screening brief intervention and referral to treatment; RAAM, rapid access addiction medicine clinic. Remember: Use lorazepam, not diazepam, if advanced cirrhosis/acute hepatitis, elderly, on respiratory depressants.
|
NALTREXONE |
GABAPENTIN |
|
Naltrexone 25mg PO daily x 4d, then 50mg PO daily ~$2.81 per pill, or LU code 532 if on Ontario Drug Benefit/ODSP Contraindications: – Liver disease (LFTs >3x ULN) – Pregnancy – Opioid use Prescribe enough to get to follow-up – F/U MANDATORY within 2-4 weeks for response to treatment, and to monitor LFTs and mood. Alternative in liver disease = Acamprosate 333mg po TID, LU code 531 |
Gabapentin 400mg PO TID x 7 days $0.13 per pill For use as an adjunct after benzodiazepine load in ED Contraindications: – Liver failure – Do not use as monotherapy if high risk for severe withdrawal/seizure/delirium
|
2. If your patient has recovered from intoxication / is not yet in withdrawal and planning to stop:
PAWSS, Prediction of Alcohol Withdrawal Severity Scale (see mdcalc); SBIRT, screening brief intervention and referral to treatment; RAAM, rapid access addictions medicine clinic; F/U, follow-up.
