Section Review Central & Peripheral Nervous Systems: Treatment for alcohol withdrawal: recent developments

Abstract

Alcohol withdrawal syndrome (AWS) represents a physiologic response of central nervous system excitation following cessation or reduction in consumption of ethanol. Consequences of alcohol withdrawal may lead to seizures and collapse of the cardiopulmonary system and, indeed, pose significant morbidity and mortality. Historically, withdrawal has been treated with a number of agents, including ethanol, paraldehyde, and phenobarbital, which produced untoward effects of toxicity, tolerance, and physical dependence. The treatment of withdrawal symptoms, especially the most severe form (delirium tremens), has been challenging owing to difficulties with drug titration, toxicity, and the lack of standardised protocols. The introduction of the benzodiazepines has afforded clinicians a greater safety profile in the management of AWS. The best ‘treatment’ for AWS lies in recognising the potential for its occurrence and providing prophylaxis, especially in surgical patients where consequences can be severe. The use of benzodiazepines has proven to be of benefit not only in prophylaxis but in all stages of withdrawal, with a good safety record. Newer benzodiazepines, such as lorazepam and midazolam, have been found to offer particular advantages as a result of their pharmacokinetic profile and ease of administration. Future developments in the treatment of AWS are evolving from greater understanding of the complex neurobiology of ethanol in the central nervous system and improved methods of conducting clinical trials.