Table 2-3Drug treatment indications and cost

Drug treatment for AAW and DT*
Indication/DoseAcquisition price
Diazepam
  • By mouth, anxiety, 2 mg 3 times daily increased if necessary to 15–30 mg daily in divided doses; elderly (or debilitated) half adult dose
  • By intramuscular injection or slow intravenous injection, for severe acute anxiety, control of acute panic attacks, and acute alcohol withdrawal, 10 mg, repeated if necessary after not less than 4 hours
Diazepam (Non-proprietary)
  • Tablets, diazepam 2 mg, net price 28 = 96p; 5 mg, 28 = 99p; 10 mg, 28 = £1.03.
  • Injection (solution), diazepam 5 mg/mL. Net price 2-mL amp = 45p.
  • Injection (emulsion), diazepam 5 mg/mL. Net price 2-mL amp = 92p.
Lorazepam
  • By mouth, anxiety, 1–4 mg daily in divided doses; elderly (or debilitated) half adult dose
  • By intramuscular or slow intravenous injection (into a large vein), acute panic attacks, 25–30 micrograms/kg (usual range 1.5–2.5 mg), repeated every 6 hours if necessary; child not recommended
Lorazepam (Non-proprietary)
  • Tablets, lorazepam 1 mg, net price 28-tab pack = £8.14; 2.5 mg, 28-tab pack = £13.72.
  • Injection, lorazepam 4 mg/mL. Net price 1-mL amp = 35p.
Chlordiazepoxide
  • Anxiety, 10 mg 3 times daily increased if necessary to 60–100 mg daily in divided doses; elderly (or debilitated) half adult dose; child not recommended
Chlordiazepoxide (Non-proprietary)
  • Capsules, chlordiazepoxide hydrochloride 5 mg, net price 100-cap pack = £3.60; 10 mg, 100-cap pack = £10.39.
Chlordiazepoxide Hydrochloride (Non- proprietary)
  • Tablets, chlordiazepoxide hydrochloride 5 mg, net price 100 = £4.24; 10 mg, 100 = £11.34.
Alprazolam
  • 250–500 micrograms 3 times daily (elderly or debilitated 250 micrograms 2–3 times daily), increased if necessary to a total of 3 mg daily; child not recommended
Alprazolam (Non-proprietary)
  • Tablets, alprazolam 250 micrograms, net price 60-tab pack = £2.97;
    500 micrograms, 60-tab pack = £5.69.
Carbamazepine
  • By mouth, epilepsy, initially, 100–200 mg 1–2 times daily, increased slowly to usual dose of 0.4–1.2 g daily in divided doses; in some cases 1.6–2 g daily in divided doses may be needed; elderly reduce initial dose; child daily in divided doses, up to 1 year 100–200 mg, 1–5 years 200–400 mg, 5–10 years 400–600 mg, 10–15 years 0.4–1 g
Carbamazepine (Non-proprietary)
  • Tablet, carbamazepine 100 mg, net price 28 = £5.64; 200 mg, 28 = £4.90; 400 mg, 28 = £6.59.
Chlomethiazole
  • Restlessness and agitation in the elderly, 1 capsule 3 times daily
  • Alcohol withdrawal, initially 2–4 capsules, if necessary repeated after some hours; day 1 (first 24 hours), 9–12 capsules in 3–4 divided doses; day 2, 6–8 capsules in 3–4 divided doses; day 3, 4–6 capsules in 3–4 divided doses; then gradually reduced over days 4–6; total treatment for not more than 9 days
Heminevrin®
  • Capsules, grey-brown, clomethiazole base 192 mg in an oily basis. Net price 60-cap pack = £4.78.
Phenytoin
  • By mouth, initially 3–4 mg/kg daily or 150–300 mg daily (as a single dose or in 2 divided doses) increased gradually as necessary (with plasma-phenytoin concentration monitoring); usual dose 200–500 mg daily (exceptionally, higher doses may be used); child initially 5 mg/kg daily in 2 divided doses, usual dose range 4–8 mg/kg daily (max. 300 mg daily)
Phenytoin (Non-proprietary)
  • Tablets, coated, phenytoin sodium 100 mg, net price 28-tab pack = £30.00.
*

BNF no. 5827

From: 2, Acute Alcohol Withdrawal

Cover of Alcohol Use Disorders
Alcohol Use Disorders: Diagnosis and Clinical Management of Alcohol-Related Physical Complications [Internet].
NICE Clinical Guidelines, No. 100.
National Clinical Guideline Centre (UK).
Copyright © 2010, National Clinical Guidelines Centre.

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