medically reviewed

Medications Used to Treat Alcohol Withdrawal & Alcoholism

Learn how certain medications may be used to alleviate discomfort and decrease worsening symptoms for those at risk of severe alcohol withdrawal.

Detoxing from alcohol is often the first phase of the rehabilitation process for those looking to recover from alcohol use disorder (AUD). 

When chronic or excessive alcohol use leads to significant physical dependence, that person may experience withdrawal symptoms when he or she decides to quit drinking.1 

For those at risk of severe alcohol withdrawal, doctors may prescribe certain medications to alleviate discomfort, halt the progression or worsening of symptoms, and minimize the likelihood of further withdrawal complications.2 

Supervised Medical Detox 

Withdrawal following a period of long-term alcohol abuse can prove far less risky under medical supervision. American Addiction Centers offers medical detox services to aid clients in managing their alcohol withdrawal symptoms in a safe and comfortable environment. We are dedicated to helping you or your loved ones detox safely from alcohol and other drugs. 

For more information, contact us at 1-888-685-5770 . 

Free and low-cost alcoholism treatment is available.

Acute Alcohol Withdrawal Symptoms 

Symptoms of acute alcohol withdrawalmay range from mild to physically dangerous, with some relatively mild symptoms arising within 8 hours after the last drink.1 

Depending on the magnitude of physical dependence, additional symptoms may continue to arise beyond 24 hours, with some potentially severe effects emerging 2 to 4 days after abstinence.3 


Symptoms of alcohol withdrawal may include: 1,3

  • Insomnia. 
  • Irritability.  
  • Anxiety.  
  • Agitation.  
  • Mood swings.  
  • Depression.  
  • Fatigue.  
  • Nausea or vomiting.  
  • Sweating.  
  • Increased heart rate. 
  • High blood pressure. 
  • Hand tremor. 
  • Seizures (in rarer cases, severe alcohol withdrawal is associated with a syndrome known as delirium tremens, or DTs).  

Alcohol Withdrawal Syndrome Treatments 

Left unmanaged, people who are physically dependent on alcohol may experience a markedly uncomfortable and potentially life-threatening called alcohol withdrawal syndrome when attempting to quit this drug. In such instances, a supervised medical detox may be needed to effectively manage symptoms and decrease the risk of complications (such as seizures) to best promote continued abstinence in early recovery.2

As a part of this process, medications may be given at the onset of symptoms and continued until they subside.4

Though more than 150 medications have been explored for the treatment of alcohol withdrawal, there continues to be some disagreement regarding the best pharmacologic approaches to withdrawal management.2

What Are Delirium Tremens? 

In some instances of pronounced alcohol dependence and severe accompanying withdrawal, a person may develop a neurological syndrome called delirium tremens (DTs) that is characterized autonomic nervous system excitation and significant changes in mental status.5

Though relatively rare, DTs are most commonly seen in those with a history of alcohol withdrawal and who’ve abused alcohol for more than 10 years, or drink daily, for months on end.5

Typically, DTs are only present in around 5% of patients experiencing withdrawal.2

Delirium tremens symptoms may include:5 

  • Hallucinations. 
  • Agitation. 
  • Severe confusion or disorientation.
  • Seizures. 

If you suspect you or someone you know is experiencing this form of withdrawal, seek medical attention immediately. Delirium tremens may prove highly dangerous and even life-threatening if left untreated. 

If you suspect you or someone you know is experiencing this form of withdrawal, seek medical attention immediately. 

Medications Used to Treat Alcoholism and Alcohol Withdrawal Symptoms 

In significantly severe cases of alcohol withdrawal, detoxification professionals may administer medications to manage symptoms. Although some withdrawal episodes may appear to not need pharmacological intervention, foregoing medications may, in some cases, have adverse consequences for any future withdrawal episodes.2 

The failure to adequately manage withdrawal with medications with could result in a type of neurotoxicity which, by way of a phenomenon “kindling”, could put patients at a greater risk of seizures following repeated withdrawal episodes.2

Benzodiazepines for Alcohol Withdrawal 

Used to treat panic, anxiety, and to control certain types of seizures, benzodiazepines are a class of sedative medications. These drugs are physicians’ agents of choice to manage a large portion of the more problematic alcohol withdrawal symptoms. For example, benzodiazepines can significantly reduce the risk of seizures in those suffering from alcohol withdrawal symptoms. 2,3

Frequently used benzodiazepine pharmaceutical agents used to treat alcohol withdrawal symptoms include chlordiazepoxide (Librium) and diazepam (Valium).6 

Longer-acting benzodiazepines with active metabolites are common first-line medications since their use may result in a lower chance of recurrent withdrawal or seizures.6 Shorter-acting benzodiazepines may play a relatively more important role for withdrawal mangement in the elderly or in those with chronic liver issues directly related.2 

FDA-Approved Benzodiazepines 

Benzodiazepines that are specifically FDA-approved to manage acute alcohol withdrawal syndrome include:7 

  • Chlordiazepoxide (e.g., Librium). 
  • Clorazepate (e.g., Tranxene). 
  • Diazepam (e.g., Valium). 
  • Oxazepam (e.g., Serax). 

Anticonvulsant Medication

Besides benzodiazepines, physicians sometimes prescribe other seizure medications to help manage acute alcohol withdrawal syndrome. during severe alcohol withdrawal. Some of the additional anticonvulsant medications that may be utilized to help manage alcohol withdrawal include:8  

  • Carbamazepine (e.g., Tegretol)  
  • Gabapentin (e.g., Neurontin)  
  • Oxcarbazepine (e.g., Trileptal)  
  • Valproic Acid (e.g., Depakene)  

Depending on the specific person suffering from alcohol withdrawal, seizure medications may either be used as a replacement for benzodiazepines, or alongside benzodiazepines. One imperative perk of these types of anticonvulsants is that they have less potential for abuse than benzos. However, these medications don’t necessarily prevent DTs or grand-mal seizures.8 

Barbiturates for Alcohol Withdrawal 

Barbituratesare another class of drugs that may be used to treat alcohol withdrawal symptoms in benzodiazepine-resistant cases of alcohol withdrawal syndrome. In particular, their use in the emergency department and in the intensive care unit for severe cases of alcohol withdrawal has shown immense promise. However, to clarify the distinct role of barbiturates in alcohol withdrawal syndrome, additional studies are needed.8

FDA-Approved Medications to Treat Alcoholism and Alcohol Dependence 

Aside from medications used for treating alcohol withdrawal syndrome, other medications may be used within recovery programming to treat alcoholism such as: 

Disulfiram (Antabuse) 

Disulfiram inhibits an enzyme used to metabolize alcohol. Regular maintenance use of disulfiram will result in unpleasant effects even when someone consumes small amounts of alcohol.9  

When used as prescribed, to help a person stop drinking, these effects may begin to be felt as soon as 10 minutes after consuming alcohol and include anxiety, headache, flushing of the face, sweating, blurred vision, nausea, and vomiting.9

In turn, these effects may discourage a drinker from drinking and could lead them to associate drinking with these negative symptoms.  Typically, effects can last for 1 hour or more. Through its aversive reaction with alcohol, disulfiram is used to discourage continued drinking behavior.9

Naltrexone (Vivitrol, Revia) 

Originally used in treating individuals with opioid use disorders, naltrexone was approved in 1994 by the FDA as treatment for alcohol dependence.11
Although the precise way naltrexone works to decrease drinking behavior isn’t entirely understood, reports from patientswho’ve successfully been treated with the drug suggest that its effects include reducing the urge or desire to drink, helping them stay abstinent and interfering with their desire to continue drinking if they have a sip of alcohol.11  

Naltrexone may cause liver damage when taken in large doses and should not be given to patients with hepatitis or liver disease.13

Acamprosate (Campral) 

Used alongside counseling and social support, acamprosate is thought to restore a balance in the central nervous system between the glutamate and gamma-aminobutyric acid (GABA), excitatory and inhibitory neurotransmitters, respectively.14

Acamprosate does not prevent symptoms of alcohol withdrawal and may not be effective in those who have not stopped drinking alcohol, drink it in large amounts, or abuse other substances.15

In contrast with other FDA-approved treatments for alcohol dependence (naltrexone and disulfiram), because acamprosate is not metabolized by the liver and does not adversely interact with alcohol, it can be used in patients with liver disease or hepatitis, as well as in those who continue to drink.14 

However, according to several trials, it doesn’t appear to be more successful than naltrexone or disulfiram in reducing drinking behavior.14

Alternative and Contraindicated Agents 

Along with benzodiazepines, other drugs are sometimes administered to reduce the frequency and intensity of minor withdrawal symptoms.6  

More study on these agents is needed, as some of them may mask the hemodynamic signs of withdrawal (e.g., blood pressure changes), which can precede seizures.6Such medications include:12,22,23

  • Antipsychotics (e.g., haloperidol)— Individuals with a co-occurring thought disorder (e.g., schizophrenia) might be administered antipsychoticmedications.6Caution will be used since certain antipsychoticagents may also lower the seizure threshold.  
  • Anticonvulsants (e.g., carbamazepine)— Anticonvulsant therapy should not be used with isolated alcohol withdrawal seizures; however, carbamazepine may have some utility in outpatient management of mild alcohol withdrawal.  
  • Centrally Acting Alpha-2 Agonists (e.g., clonidine)— Certain types of antihypertensive medications, such as clonidine, have been shown to reduce adrenergic symptoms, but don’t prevent seizures.
    These drugs may assist in controlling mild or non-complicated alcohol withdrawal symptoms such as high blood pressure, sweating, anxiety, irritability, and tremors.  
  • BetaBlockers (e.g., propranolol, atenolol) — Beta blockers reduce adrenergic symptoms of alcohol withdrawal but do not preventthe development of seizures or delirium tremens 
  • Baclofen— Baclofen is a skeletal muscle relaxant and selective agonist of the GABA-B receptor. It has been studied as a therapy for acute alcohol withdrawal and shows potential to rapidly reduce symptoms. However, its effectiveness in controlling severe symptoms remains unproven.  

Sources
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[1]. MedlinePlus (2016). Alcohol Withdrawal. 

[2]. Hugh Myrick, M.D., and Raymond F. Anton, M.D. (1998). Treatment of Alcohol Withdrawal. Alcohol Health & Research World; 22(1): 38-43. 

[3]. National Clinical Guideline Centre. (2010). Alcohol Use Disorders: Diagnosis and Clinical Management of Alcohol-Related Physical Complications. NICE Clinical Guidelines, 100(2). 

[4]. Kattimani, S. and Bharadwaj, B. (2013). Clinical Management of Alcohol Withdrawal: A Systematic Review. Ind Psychiatry; Jul-Dec 22 (2); 100-108. 

[5]. U.S. National Library of Medicine. (2018). Delirium Tremens (DT). 

[6]. UpToDate. (2019). Management of moderate and severe alcohol withdrawal syndromes. 

[7]. Tarascon Publishing. (2019). Tarascon Pocket Pharmacopoeia, 2019 Deluxe Lab-Coat Edition.  

[8]. Martin, K., Katz, A. U.S. National Library of Medicine. (2016). The Role of Barbiturates for Alcohol Withdrawal Syndrome. Psychosomatics; 57(4): 341-347. 

[9]. MedlinePlus. (2017). Disulfiram. 

[10]. U.S. National Library of Medicine. (1990). Disulfiram Treatment of Alcoholism. Am J Med.; 88(6): 647-55. 

[11]. Substance Abuse and Mental Health Services Administration. (2009). Incorporating Alcohol Pharmacotherapies into Medical Practice. Treatment Improvement Protocol (TIP) Series, No. 49(4), 27-35. 

[12]. National Institute on Alcohol Abuse and Alcoholism. (1995). Answers to Frequently Asked Medication Questions. Guidelines for the Use of Naltrexone in the Treatment of Alcoholism; 5(1). 

[13]. MedlinePlus. (2017). Naltrexone. 

[14]. U.S. National Library of Medicine. (2012). Acamprosate For Treatment of Alcohol Dependence: Mechanisms, Efficacy, and Clinical Utility. Therapeutics and clinical risk management; 8, 45-53.  

[15]. MedlinePlus. (2016). Acamprosate. 

[16]. Herbert L. Muncie Jr., MD; Yasmin Yasinian, MD; Linda Oge, MD. (2013). Outpatient Management of Alcohol Withdrawal Syndrome. Am Fam Physician; 88(9):589-595. 

[17]. Liu  J, Wang  LN. (2017). Baclofen for alcohol withdrawal. Cochrane Systematic Reviews – Intervention.