1. If your patient fits DSM5 diagnostic criteria for alcohol withdrawal:

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:

alcohol withdrawal

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.

Michael Wong

Michael Wong

Dr. Michael Wong is a 4th year Emergency Medicine Resident at the University of Ottawa with a special interest in end-of-life communication, health literacy, and simulation. Michael is currently a Point-of-Care Ultrasound Fellow.
Alex Coutin

Alex Coutin

Dr. Coutin is a second-year resident in Emergency Medicine at the University of Ottawa with special interests in social advocacy, LGBTQ health, addictions, public health, POCUS, physician wellness, and medical education. He is a junior editor with the Digital Scholarship and Knowledge Dissemination team for the EMOttawaBlog.