20
Treatment – Ambulatory
(6) Phenobarbital
Î Recommendation IV.37: Phenobarbital can be used for some patients
in Level 2-WM ambulatory settings. However, it should only be used
by clinicians experienced with its use given its narrow therapeutic
window and side effects.
Î Recommendation IV.38: In a Level 2-WM ambulatory setting (e.g.,
with extensive monitoring), phenobarbital monotherapy (managed
by a clinician experienced with its use) is an appropriate alternative
to benzodiazepines for patients who are experiencing severe alcohol
withdrawal or who are at risk of developing severe or complicated
alcohol withdrawal or complications of alcohol withdrawal.
Î Recommendation IV.39: In a Level 2-WM ambulatory setting (e.g.,
with extensive monitoring), phenobarbital monotherapy (managed
by a clinician experienced with its use) is appropriate for patients
with a contraindication for benzodiazepine use who are experiencing
moderate or severe alcohol withdrawal or who are at risk of developing
severe or complicated alcohol withdrawal or complications of alcohol
withdrawal.
(7) A2AAs and beta-blockers
Î Recommendation IV.40: Alpha2-adrenergic agonists (A2AAs) such
as clonidine can be used as an adjunct to benzodiazepine therapy to
control autonomic hyperactivity and anxiety when symptoms are not
controlled by benzodiazepines alone. They should not be used alone to
prevent or treat withdrawal-related seizures or delirium.
Î Recommendation IV.41: Beta-adrenergic antagonists (beta-blockers)
can be used as an adjunct to benzodiazepines in select patients for
control of persistent hypertension or tachycardia when these signs are
not controlled by benzodiazepines alone. They should not be used to
prevent or treat alcohol withdrawal seizures.
(8) Inappropriate medications
Î Recommendation IV.42: Oral or intravenous alcohol should not be
used for the prevention or treatment of alcohol withdrawal.
Î Recommendation IV.43: There is insufficient evidence to support the
use of baclofen for the treatment of alcohol withdrawal.
Î Recommendation IV.44: Providing magnesium as a prophylaxis or
treatment for alcohol withdrawal management has no supporting
evidence.
