34
Treatment
D. Patients with Medical Conditions
Î Recommendation VII.21: For patients with medical comorbidities,
modify the medication and/or protocol used for treating alcohol
withdrawal syndrome as necessary in consultation with other
specialists.
Î Recommendation VII.22: For patients with medical conditions
that prevent the use of oral medication, provide intravenous or
intramuscular medications as necessary.
Î Recommendation VII.23: Aggressive withdrawal treatment is
indicated for patients with cardiovascular disorders due to risk of
harm associated with autonomic hyperactivity.
Î Recommendation VII.24: For patients with a medical condition
associated with impaired hepatic function, adjust medication dose or
use medications with less dependence on hepatic metabolism.
E. Patients who Take Opioids
Î Recommendation VII.25: Patients who are on chronic opioid medication
(opioid agonist therapy for opioid use disorder or pain) should be
monitored closely when benzodiazepines are prescribed, due to the
increased risk of respiratory depression. Similarly, patients taking
sedative-hypnotic medications exhibit tolerance to benzodiazepines and
should be monitored closely for appropriate dose.
Î Recommendation VII.26: For patients with concomitant alcohol
withdrawal and opioid use disorder, stabilize opioid use disorder (e.g.,
with methadone or buprenorphine) concomitantly with treating alcohol
withdrawal.
F. Patients who are Pregnant
(1) Level of care and monitoring
Î Recommendation VII.27: Inpatient treatment should be considered for
all pregnant patients with alcohol use disorder who require withdrawal
management. Inpatient treatment should be offered to pregnant
patients with at least moderate alcohol withdrawal (i.e., CIWA-Ar
scores ≥10).
Î Recommendation VII.28: The CIWA-Ar is an appropriate symptom
assessment scale to use with pregnant patients. Clinicians should
consider signs and symptoms such as nausea, headache, anxiety, and
insomnia to be connected to alcohol withdrawal rather than pregnancy
that will abate once the alcohol withdrawal has been effectively treated.
Î Recommendation VII.29: During withdrawal management, consult
with an obstetrician.
