Table 21Titrated fixed-dose chlordiazepoxide protocol for treatment of alcohol withdrawal (Ghodse et al., 1998; South West London and St George's Mental Health NHS Trust, 2010)

Typical recent daily consumption15 to 25 units30 to 49 units50 to 60 units
Severity of alcohol dependenceMODERATE SADQ score 15 to 25SEVERE SADQ score 30 to 40VERY SEVERE SADQ score 40 to 60
Starting doses of chlordiazepoxide15 to 25 mg q.d.s.130 to 40 mg q.d.s.50 mg q.d.s.
Day 1 (starting dose)15 q.d.s.25 q.d.s.30 q.d.s.40 q.d.s.*50 q.d.s.*
Day 210 q.d.s.20 q.d.s.25 q.d.s.35 q.d.s.45 q.d.s.
Day 310 t.d.s.215 q.d.s.20 q.d.s.30 q.d.s.40 q.d.s.
Day 45 t.d.s.10 q.d.s.15 q.d.s.25 q.d.s.35 q.d.s.
Day 55 b.d.310 t.d.s.10 q.d.s.20 q.d.s.30 q.d.s.
Day 65 nocte45 t.d.s.10 t.d.s.15 q.d.s.25 q.d.s.
Day 75 b.d.5 t.d.s.10 q.d.s.20 q.d.s.
Day 85 nocte5 b.d.10 t.d.s.10 q.d.s.
Day 95 nocte5 t.d.s.10 q.d.s.
Day 105 b.d.10 t.d.s.
Day 115 nocte5 t.d.s.
Day 125 b.d.
Day 135 nocte

Note.

*

Doses of chlordiazepoxide in excess of 30 mg q.d.s. should only be prescribed in cases where severe withdrawal symptoms are expected and the patient's response to the treatment should always be regularly and closely monitored. Doses in excess of 40 mg q.d.s. should only be prescribed where there is clear evidence of very severe alcohol dependence. Such doses are rarely necessary in women and never in the elderly or where there is severe liver impairment.

1

Quater die sumendus (four times a day);

2

ter die sumendum (three times a day);

3

bis die (twice daily);

4

At night.

From: 5, ORGANISATION AND DELIVERY OF CARE

Cover of Alcohol-Use Disorders
Alcohol-Use Disorders: Diagnosis, Assessment and Management of Harmful Drinking and Alcohol Dependence.
NICE Clinical Guidelines, No. 115.
National Collaborating Centre for Mental Health (UK).
Leicester (UK): British Psychological Society; 2011.
Copyright © 2011, The British Psychological Society & The Royal College of Psychiatrists.

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