Detox Local

Alcohol Withdrawal Medication Guide

Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN

Written By: Phillippe Greenough

Article Updated: 09/25/2020

Number of References: 6 Sources

There is a wide range of alcohol withdrawal medications that are commonly used to ease the inherent pain and discomfort commonly felt during the alcohol detoxification process. These medications may help reduce both the physical and psychological symptoms of withdrawal. We take an in-depth look at the current medications which are used in the treatment of alcohol withdrawal as well as medications that are currently being developed.

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The Vital Importance of Medications

The major issues related to alcohol withdrawal, both acute and post-acute, involve the neurotransmitters GABA, glutamate, norepinephrine, and to a lesser degree dopamine and serotonin. Most alcohol withdrawal medications work either directly or indirectly on these neurotransmitter pathways, some more selectively than others.

The issues that arise in acute and post-acute alcohol withdrawal are discrete problems that require specific medications to treat each set of symptoms in turn. Additionally, there are quite a few alcohol detox medications that are used in special circumstances, such as refractory withdrawal and refractory delirium tremens. Refractory simply means that it is not responding to normal treatment methods. These medications are not used regularly, as refractory issues are by definition uncommon, but are considered first-line treatment for refractory complications.

Without withdrawal medications, the risk of serious health complications during detox increases substantially.

Medications Used To Treat Withdrawal

The acute phase of withdrawal is extremely dangerous because of the risk of seizure, heart problems, delirium, and death. Thankfully, there are a number of alcohol detox medications that effectively treat these issues, and provide a safe withdrawal experience when coupled with appropriate medical oversight.

Benzos as a First Line Treatment

Benzodiazepines are a very effective class of drugs used to treat both physical and neurological symptoms of alcohol withdrawal. They are the first choice for treating alcohol withdrawal and can relieve anxiety, lower risk of seizure, and reduce general nervous system hyperactivity. Some of the most commonly used benzo medications include:

  • Chlordiazepoxide (Librium)
  • Lorazepam (Ativan)
  • Alprazolam (Xanax)
  • Oxazepam (Serax)
  • Clorazepate (Tranxene)
  • Diazepam (Valium)
Benzodiazepines For Alcohol Withdrawal

Secondary Withdrawal Medications

While benzodiazepines are the first choice, there is a variety of other medications that may also be effective. Some of the other most commonly used alcohol withdrawal medications include:

  • Blood Pressure Medications: Either beta-blockers or the alpha-2 agonist clonidine (Catapres), these medications can lower blood pressure and sometimes reduce anxiety or pain. Some commonly used beta-blockers include metoprolol (Lopressor), propranolol (Inderal), and atenolol (Tenormin).
  • GABA Receptor Agonists: These may be used off label for alcohol withdrawal, but have shown great promise in treating withdrawal. Gabapentin (Neurontin), while not technically a GABA agonist, is an anticonvulsant and is also used to treat certain kinds of pain, while baclofen (Gablofen) is used to treat muscle spasms. These can help reduce the GABA imbalances during withdrawal.
  • Barbiturates: In the absence of available benzodiazepines, or if a patient is not responding to them, older barbiturates such as phenobarbital (Luminal) may be used as an adjunct alcohol withdrawal medication.
  • Anticonvulsants: Certain drugs of this class, such as carbamazepine (Tegretol) and valproic acid (Depakote), have been found useful in reducing the subjective symptoms of acute alcohol withdrawal. They may also prevent status epilepticus seizures during delirium tremens. Additionally, newer medications in this class such as zonisamide (Zonegran) and topiramate (Topamax) may more effectively reduce the subjective experience of acute withdrawal symptoms.
  • Anesthetics: Typically used as a last resort in refractory alcohol withdrawal and refractory DT cases, these medications are used to lower the hyperactive vital signs to safer levels. The most commonly used medication of this type is propofol (Diprivan), although the use of this medication is reserved as it comes with its own set of risks.

Medications for Post-Acute Alcohol Withdrawal

The post-acute phase of alcohol withdrawal presents its own challenges, mainly in the realm of mental symptoms such as depression, cravings, and anxiety. Luckily, there are a variety of alcohol withdrawal medications that are commonly used to treat these symptoms as well. The most widely used include:

  • Naltrexone (Vivitrol): Originally used to treat heroin addiction, this medication has also proved very effective at treating alcohol use disorders. It is now standard practice to use this medication during and after alcohol detox. It is an opioid antagonist, which acts on the natural opioid system of the brain and can reduce cravings for alcohol or other drugs.
  • Acamprosate (Campral): The exact way this medication works is not well understood, however, it does appear to lower glutamate levels as well as raise GABA levels in the brain. This may help to reduce the negative symptoms of post-acute alcohol withdrawal. Used as part of post-detox treatment, when this medication is used in conjunction with support groups and therapy, it has been shown to improve adherence to treatment plans and may reduce cravings.
  • Antidepressants: This is a large and general classification of medications which includes SSRI and tricyclic antidepressants. These are used to treat depression and some may also help with anxiety and insomnia. Some of the more common SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and escitalopram (Lexapro). The commonly used tricyclic antidepressants include amitriptyline (Elavil), desipramine (Norpramin), and imipramine (Tofranil). It is not uncommon for these symptoms to persist for many months after detox, so antidepressants are one of the most frequently prescribed medications during post-acute withdrawal.
  • Disulfiram (Antabuse): This is a unique medication whose only use is in the treatment of alcohol use disorder. This medication changes the way alcohol is metabolized and produces very strong negative consequences if alcohol is consumed while taking this medication. The symptoms of drinking while on disulfiram include chest pain, nausea, dizziness, intense thirst, and elevated heart rate.
  • Propranolol (Inderal): Aside from the originally intended use as a medication to manage blood pressure, it also helps reduce anxiety in a non-mind-altering manner.

Investigational Alcohol Withdrawal Medications

Due to the large numbers of people seeking treatment for alcohol use disorder, there are several promising alcohol withdrawal medications that are currently being investigated for use in the United States and Europe. Since these medications are under development, these results are inconclusive at the present, and any attempt to try these treatments should be done only under the supervision of a doctor.

  • Memantine (Axura): This is a fairly new medication intended to treat the dementia-like symptoms of Alzheimer’s disease. It works by blocking glutamate receptors which lead to the neural hyperactive symptoms experienced during acute alcohol withdrawal. In some studies, it has been shown to be as effective as diazepam in reducing the subjective discomfort felt, and even more effective than diazepam at reducing tremors. It has been recommended as an adjunct treatment medication.
  • Clomethiazole (Heminevrin): Commonly used in Europe as an acute stage alcohol withdrawal medication this drug is a GABA agonist which acts as both a sedative and an anticonvulsant. Compared to diazepam, it produces a shorter withdrawal period although the subjective experience of acute withdrawal was similar between the two.
  • Tiapride (Tiapridal): A highly selective dopamine agent, this drug is commonly used as an antipsychotic and tremor reducer. It has been studied for use in treating acute alcohol withdrawal and specifically when combined with carbamazepine it has shown promise as an adjunct medication.
  • Pregabalin (Lyrica): A GABA agonist similar to gabapentin, this medication is commonly used to treat chronic nerve pain. The mechanism of action is not fully understood, but it may help reduce anxiety and cravings during post-acute withdrawal.
  • Lamotrigine (Lamictal): An anticonvulsant as well as a bipolar treatment medication, it has promise as a treatment for co-occurring mental health issues and alcohol use disorder. When combined with clozapine, it has shown to reduce relapse and cravings in patients with co-occurring refractory schizophrenia and alcohol use disorder. Likewise, it has shown great promise in treating co-occurring bipolar disorders with alcohol use disorder, both reducing cravings and improving mood in general.
  • Tiagabine (Gabitril): A GABA agent used as an anticonvulsant as well as a treatment for panic disorders, the exact way this potential alcohol withdrawal medication works is not fully understood. It has been shown to reduce relapse rates in double-blind studies and is being investigated further for use during post-acute withdrawal.

The Importance of Detox

These medications are some of the most well known, but there are many other options available. In addition to medications, therapeutic techniques and dietary supplements have been found helpful and effective for the treatment of alcohol withdrawal. Finding a professional alcohol detox center will give someone access to trained medical professionals who can help them discover the available medications and treatments which will be the most effective and applicable to them.

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