Withdrawal Syndromes Follow-up

Updated: Oct 18, 2020
  • Author: Nathanael J McKeown, DO; Chief Editor: David Vearrier, MD, MPH  more...
  • Print

Further Outpatient Care

Various regimens are described for outpatient management of alcohol withdrawal syndrome, but the simplest involve administering benzodiazepines with a short half-life and few metabolites (eg, oxazepam) to prevent the accumulation of sedating compounds. This drug is initially administered frequently and in higher doses, with gradual lengthening of the dosing interval and reduction of the dose over 1 week.

Patients must be reliable enough to adjust their own medications, and they must be able to tolerate oral medications.

Low doses of clonidine (eg, 0.1-0.2 mg PO tid) can help reverse central adrenergic discharge, thus relieving tachycardia, hypertension, tachypnea, tremor, and (possibly) some craving for alcohol.

The use of beta-blockers to diminish tachycardia, hypertension, and perhaps anxiety has been described. These drugs are occasionally useful, but their effects mask the warning signs of autonomic hyperactivity if the patient develops delirium tremens (DT). [31]

Addiction treatment programs

Referral of patients with chronic alcoholism or intravenous drug use to ongoing treatment programs is worthwhile, even if only a minority of these patients maintain sobriety for long periods. Numerous agencies offer inpatient and outpatient treatment programs; the most successful groups appear to be Alcoholics Anonymous and Narcotics Anonymous.

The following options are available for people addicted to heroin:

  • Methadone is a long-acting opiate that prevents occurrence of somatic withdrawal symptoms but does not produce sedation or euphoria equivalent to heroin.

  • Buprenorphine is a μ-opioid agonist/antagonist and is prescribed in a manner that is similar to methadone.

  • Both treatment programs require patient compliance and motivation. This appears to be the limiting factor in their success rates.

  • Patients withdrawing from chronic stimulant abuse are best cared for under medical supervision; refer these patients to appropriate institutions or agencies.


Further Inpatient Care

Treatment considerations include the following:

  • Symptoms of alcohol withdrawal are often mild or absent in the emergency department (ED) and may manifest only after the patient is admitted to the hospital for other reasons (eg, multiple trauma).

  • Patients already manifesting advanced stages of withdrawal in the ED (eg, seizure, DT) require admission.

  • Patients with DT require admission to the intensive care unit (ICU) because their hemodynamic picture can change rapidly and because appreciable mortality is associated with DT.

  • Patients may require admission for associated conditions (eg, gastrointestinal bleed, pancreatitis). In these cases, use of sedatives may be more complex if the patient is hypotensive from blood or third-space fluid losses.

  • In uncomplicated cases of withdrawal, the sedative regimen can be continued until the patient is calm and vital signs are normalized. At that point, decreasing the dose or increasing the dosing interval over 3-4 days can taper the administration of sedatives.



See the list below:

  • Because of the risk of seizures, patients in active withdrawal from alcohol are unstable for transfer until they have received adequate sedation.

  • Decisions about when to transfer largely depend on underlying associated conditions that may have stabilization requirements of their own (eg, pancreatitis, acute MI).

  • Patients in opiate withdrawal are generally stable for transfer unless underlying conditions render them unstable.



Numerous complications are associated with long-term alcohol and intravenous drug abuse. Complications are more common and more serious in alcohol withdrawal than in opiate or stimulant withdrawal.

Alcohol withdrawal complications

Metabolic complications of alcohol withdrawal include the folllowing:

Cardiac complications include Takotsubo cardiomyopathy. [11]

Gastrointestinal complications of alcohol withdrawal include the folllowing:

  • Gastrointestinal bleeding (eg, peptic ulcer, esophageal varices, gastritis)
  • Hepatic cirrhosis

Infectious complications of alcohol withdrawal include the folllowing:

  • Pneumonia
  • Meningitis
  • Cellulitis

Neurologic complications of alcohol withdrawal include the folllowing: