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    CMAJ. 1999 Mar 9;160(5):675-80.

    Diagnosis and management of acute alcohol withdrawal.

    Holbrook AM, Crowther R, Lotter A, Cheng C, King D.

    Centre for Evaluation of Medicines, St. Joseph's Hospital, Hamilton, Ont.

    Alcohol abuse produces a considerable burden of illness in the Canadian population. The diagnosis of alcohol dependence and withdrawal can be difficult, particularly in the setting of covert intake or comorbidity. Two validated scales, the CAGE questionnaire to screen for alcohol abuse and dependence and the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale to assess the severity of withdrawal, are valuable tools for clinicians to use on a regular basis. For the treatment of alcohol withdrawal, compelling anecdotal evidence supports the routine administration of thiamine, but not necessarily other vitamins. Phenytoin has not been shown to be superior to placebo for uncomplicated withdrawal seizures. Neuroleptics are not recommended for routine use. Sedation with benzodiazepines guided by the CIWA-Ar results is recommended. There is good evidence that the management of alcohol withdrawal can be improved with the routine use of the CIWA-Ar scale to assess severity, treatment with adequate doses of benzodiazepines and follow-up monitoring of patients in alcohol withdrawal.

    PMID: 10102003 [PubMed - indexed for MEDLINE]

    PMCID: 1230114

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    Patient drug information

    • Phenytoin (Dilantin®, Dilantin® Infatabs®, Dilantin® Kapseals®, ...)

      Phenytoin is used to control certain type of seizures, and to treat and prevent seizures that may begin during or after surgery to the brain or nervous system. Phenytoin is in a class of medications called anticonvulsant...

    • Thiamine

      Thiamine is a vitamin used by the body to break down sugars in the diet. The medication helps correct nerve and heart problems that occur when a person's diet does not contain enough thiamine.