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There are a number of detoxification regimes and most have been devised locally
from experience.
It is important to identify a regime that you are confident works for you
and your patients though all regimes should be flexible. The dose should be
tailored to the person's age, gender and level of drinking prior to detox and
adjusted during the detox dependent upon symptoms, ideally using a validated
withdrawal symptoms assessment tool such as Alcohol Withdrawal Assessment Scoring
Guidelines (CIWA-Ar) (1).
- doses and the length of detoxification will vary dependent upon the patient
- first line treatment for the management of assisted withdrawals from alcohol
is chlordiazepoxide. The use of chlordiazepoxide and diazepam have the strongest
evidence base in the management of detoxification. Sodium valproate or phenytion
may also reduce or stop severe withdrawal symptoms during detoxification
- detoxification programme using chlordiazepoxide:
- titrate against the amount of alcohol the patient is using and the severity
of the withdrawals they are experiencing
- regime needs to fit individual need and symptoms
- Severity of Alcohol Dependence Questionnaire (SADQ-C) (2) can be used
- give at least 4 hours between doses
- use capsules rather than tablets (see drug tariff - this is less expensive)
- other medication may occasionally be required for the control of symptoms
such as diarrhoea, vomiting and itching
Example treatment regime (from Camden PCT primary care alcohol detox protocol
2008)
Reference:
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