Identification and management of alcohol withdrawal syndrome

Drugs. 2015 Mar;75(4):353-65. doi: 10.1007/s40265-015-0358-1.


Symptoms of alcohol withdrawal syndrome (AWS) may develop within 6-24 h after the abrupt discontinuation or decrease of alcohol consumption. Symptoms can vary from autonomic hyperactivity and agitation to delirium tremens. The gold-standard treatment for AWS is with benzodiazepines (BZDs). Among the BZDs, different agents (i.e., long-acting or short-acting) and different regimens (front-loading, fixed-dose or symptom-triggered) may be chosen on the basis of patient characteristics. Severe withdrawal could require ICU admission and the use of barbiturates or propofol. Other drugs, such as α2-agonists (clonidine and dexmetedomidine) and β-blockers can be used as adjunctive treatments to control neuroautonomic hyperactivity. Furthermore, neuroleptic agents can help control hallucinations. Finally, other medications for the treatment for AWS have been investigated with promising results. These include carbamazepine, valproate, sodium oxybate, baclofen, gabapentin and topiramate. The usefulness of these agents are discussed.

Publication types

  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adrenergic Antagonists / administration & dosage
  • Alcohol Withdrawal Delirium / diagnosis
  • Alcohol Withdrawal Delirium / drug therapy
  • Alcohol Withdrawal Delirium / physiopathology
  • Alcoholism / diagnosis*
  • Alcoholism / drug therapy*
  • Alcoholism / physiopathology
  • Animals
  • Antipsychotic Agents / administration & dosage
  • Benzodiazepines / administration & dosage
  • Disease Management*
  • Drug Therapy, Combination
  • Humans
  • Substance Withdrawal Syndrome / diagnosis*
  • Substance Withdrawal Syndrome / drug therapy*
  • Substance Withdrawal Syndrome / physiopathology


  • Adrenergic Antagonists
  • Antipsychotic Agents
  • Benzodiazepines