These recommendations, from the American Society of Addiction Medicine Committee on Practice Guidelines, were developed by carrying out a structured review of articles on ethanol withdrawal in human subjects. Outcomes evaluated included severity of withdrawal, occurrence of seizures or delirium, adverse effects, and cost. 134 articles were identified, including 65 prospective trials utilizing 42 different medications. Continuous infusion with short-acting agents has not proved superior to other regimens, and may incur substantially increased medication costs.
Barbiturates are less safe than BZDs.
Evidence does not support the routine use of beta-blockers, clonidine, carbamazepine, neuroleptic agents, magnesium, or ethanol drips. BZDs are the preferred agents. All patients with ethanol withdrawal should be given thiamine. Our experience is that these patients often need large doses of BZDs, and that the risk of inadequate sedation is much greater than the theoretical possibility of over-medication. The American Society of Addiction Medicine's homepage includes additional guidelines and position papers.