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 25mg PO daily x 4d, then 50mg PO daily
~$2.81 per pill, or LU code 532 if on Ontario Drug Benefit/ODSP
– Liver disease (LFTs >3x ULN)
– 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
– 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.
Dr. Michael Wong is a FRCPC Emergency Physician with special interests in end-of-life communication, health literacy, and simulation. Michael also has a Point-of-Care Ultrasound Fellowship.
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Dr. Coutin (he/they) is a senior Emergency Medicine resident at the University of Ottawa with special interests in social advocacy, 2SLGBTQ+ health, addictions, public health, POCUS, physician wellness, and medical education. He is a Senior Editor with the EMOttawa Digital Scholarship and Knowledge Dissemination team.
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