Delirium tremens medication
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Effective Medications for Delirium Tremens Treatment
Introduction to Delirium Tremens
Delirium tremens (DT) is a severe and potentially fatal condition associated with alcohol withdrawal. It is characterized by symptoms such as disorientation, hallucinations, agitation, tremors, and various neurovegetative symptoms like hyperhidrosis and fluctuations in vital signs6. Prompt and adequate management is crucial to prevent complications and reduce mortality9.
Benzodiazepines: The Mainstay of Treatment
Diazepam and Lorazepam
Benzodiazepines are the cornerstone of DT treatment due to their efficacy in controlling agitation and preventing seizures. Diazepam and lorazepam are particularly favored for their anticonvulsive properties and effectiveness in managing severe withdrawal symptoms4 5. Diazepam, administered intravenously, has been shown to calm patients more rapidly compared to other medications like paraldehyde, making it a preferred choice in acute settings1. In cases where standard doses are insufficient, high doses of benzodiazepines may be required to stabilize patients, as seen with diazepam's use in prolonged DT cases2.
Midazolam
Midazolam, a short-acting benzodiazepine, has also been used in DT management. However, its association with metabolic acidosis and high cost makes it less favorable compared to diazepam2.
Alternative Medications
Chlormethiazole
Chlormethiazole, a drug with cross-tolerance to ethanol, has shown promise in reducing the incidence and severity of DT when used early in high-risk patients. This medication can prevent the onset of DT and make the condition easier to manage if it does occur3 9.
Lamotrigine
Lamotrigine, an antiepileptic drug, has been investigated for its potential in DT treatment due to its ability to inhibit excitatory glutamate release. Clinical studies have demonstrated its significant efficacy in reducing DT symptoms, although it does not impact mortality rates8.
Promazine
Promazine hydrochloride has been used effectively in treating DT, particularly in cases where the onset occurs during active drinking. This treatment has been associated with reduced mortality and shorter hospital stays, highlighting its potential benefits in specific scenarios10.
Supportive and Symptomatic Treatment
In addition to pharmacological interventions, supportive care is essential in managing DT. This includes monitoring vital signs, addressing electrolyte imbalances, and providing nutritional support. Thiamine supplementation is crucial to prevent Wernicke's encephalopathy, a common complication in chronic alcoholics7.
Conclusion
The management of delirium tremens requires a multifaceted approach, with benzodiazepines like diazepam and lorazepam being the primary treatment options due to their effectiveness in controlling severe withdrawal symptoms. Alternative medications such as chlormethiazole and lamotrigine offer additional therapeutic options, particularly in specific patient populations. Supportive care remains a critical component of treatment to ensure comprehensive management and reduce the risk of complications.
Sources and full results
Most relevant research papers on this topic
Diazepam and paraldehyde for treatment of severe delirium tremens. A controlled trial.
Diazepam is a safe and effective sedative for managing combative patients with severe delirium tremens, reducing initial calming time and requiring less medication.
RCT
Highly CitedProlonged Delirium Tremens Requiring Massive Doses Of Medication
High doses of benzodiazepine, such as diazepam, may be necessary for extended periods in delirium tremens treatment, but withholding large doses or giving up in severe cases can increase mortality.
Case ReportThe efficacy of early chlormethiazole medication in the prevention of delirium tremens. A retrospective study of the outcome of different drug treatment strategies at the Helsingborg psychiatric clincis, 1975–1980
Early chlormethiazole treatment significantly reduces the incidence of delirium tremens in acute alcohol withdrawal patients, making it a protective strategy against the disorder.
Observational StudyDelirium tremens
Diazepam is more effective than barbital in treating delirium tremens and other acute alcohol-related conditions due to its anticonvulsive properties.
Delirium Tremens: Assessment and Management.
Delirium tremens (DT) is a severe alcohol withdrawal symptom, and prompt and adequate management is crucial to prevent death.
TREATMENT OF DELIRIUM TREMENS: A comparative study of different therapeutic methods in 434 cases
Delirium tremens treatment at the Beckomberga Hospital during 1956-1960 included symptomatic measures, Band Cvitamin treatment, and various drugs, with a mortality rate of approximately 14 percent.
A Young man with Delirium Tremens, Pellagra and Alcoholic neuropathy. Case report and review of pharmacological treatment
Benzodiazepines are the first-line treatment for severe alcohol withdrawal, while antiepileptic drugs are useful for mild-moderate withdrawal and relapse prevention.
Case Report
Rigorous JournalLamotrigine augmentation in delirium tremens.
Lamotrigine augmentation is significantly efficient in treating delirium tremens, but does not decrease mortality rate.
RCTAlcohol withdrawal delirium - diagnosis, course and treatment.
Delirium tremens, the most severe complication of alcohol withdrawal, should be managed at an ICU with high doses of benzodiazepines and supportive therapy to prevent death.
Systematic ReviewHighly Cited