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Sample Medication Regimens
Regimen Description, Examples
Benzodiazepines (doses in chlordiazepoxide)
Typical single dose Mild withdrawal (CIWA-Ar <10): 25–50 mg PO
Moderate withdrawal (CIWA-Ar 10–18): 50–100 mg PO
Severe withdrawal (CIWA-Ar ≥19): 75–100 mg PO
Symptom-triggered 25–100 mg PO q4–6h when CIWA-Ar ≥10. Additional doses PRN.
Fixed-dose Taper daily total dose by 25–50% per day over 3–5 days by reducing
the dose amount and/or dose frequency. Additional doses PRN.
Day 1: 25–100 mg PO q4–6h
Day 2: 25–100 mg PO q6–8h
Day 3: 25–100 mg PO q8–12h
Day 4: 25–100 mg PO at bedtime
(Optional) Day 5: 25–100 mg PO at bedtime
Front loading Symptom-triggered: 50–100 mg PO q1–2h until CIWA-Ar <10.
Fixed-dose: 50–100 mg PO q1–2h for 3 doses.
Phenobarbital
Typical single dose 10 mg/kg IV infused over 30 minutes or 60–260 mg PO/IM.
Monotherapy Symptom-triggered in the ICU: 130 mg IV q30m to target a RASS
score of 0–1.
Fixed dose in the ED: Loading dose 260 mg IV, then 130 mg IV
q30m at physician's discretion.
Fixed dose in ambulatory management: Loading dose 60–120 mg
PO. en 60 mg PO q4h until patient is stabilized. en 30–60
mg PO q6h tapered over 3–7 days. Additional doses PRN.
Adjunct therapy Single dose in the ED: 10 mg/kg IV infused over 30 minutes.
Escalating dose in the ICU: Aer maximum diazepam dose (120 mg ),
if RASS ≥1, escalating dose of 60 mg ➔ 120 mg ➔ 240 mg IV
q30m to target RASS score of 0 to -2.
Carbamazepine (Tegretol)
Monotherapy 600–800 mg total per day tapered to 200–400 mg/d over 4–9 days.
Adjunct therapy 200 mg q8h or 400 mg q12h.
Gabapentin (Neurontin)
Monotherapy Loading dose 1200 mg, then 600 mg q6h on Day 1 or 1200 mg/d
for 1–3 days, tapered to 300–600 mg/d up to 4–7 days. Additional
doses PRN.
Adjunct therapy 400 mg q6–8h.
Valproic acid (Depakene)
Monotherapy 1200 mg/d tapered to 600 mg/d over 4–7 days or 20 mg/kg/d.
Adjunct therapy 300–500 mg q6–8h.
