Novel Algorithms for the Prophylaxis and Management of Alcohol Withdrawal Syndromes-Beyond Benzodiazepines

Crit Care Clin. 2017 Jul;33(3):559-599. doi: 10.1016/j.ccc.2017.03.012.


Benzodiazepine (BZDP) agents are the standard for the prophylaxis and treatment of all phases of alcohol withdrawal syndrome. However, BZDPs have their drawbacks: cognitive impairment, significant neurologic and medical side effects. There are data suggesting that the alcohol recidivism rate and abuse potential is higher for BZDPs treated patients, compared to alternatives. Clinical and research data demonstrate the efficacy and safety of various pharmacologic alternatives to benzodiazepines for the prevention and management of AWS. This article examines the available published evidence regarding the use of non-BZDP agents compared with conventional treatment modalities. The author's BZDP-sparing protocol is highlighted.

Keywords: Alcohol withdrawal; Alpha-2 agonists; Anticonvulsant agents; Benzodiazepines; Delirium tremens; Withdrawal prophylaxis.

Publication types

  • Review

MeSH terms

  • Adrenergic alpha-2 Receptor Agonists / therapeutic use*
  • Alcohol Withdrawal Delirium / prevention & control
  • Alcohol Withdrawal Delirium / therapy*
  • Algorithms*
  • Anesthetics, Intravenous / therapeutic use*
  • Anticonvulsants / therapeutic use*
  • Benzodiazepines / adverse effects
  • Benzodiazepines / therapeutic use
  • Ethanol / adverse effects
  • Humans
  • Propofol / therapeutic use*


  • Adrenergic alpha-2 Receptor Agonists
  • Anesthetics, Intravenous
  • Anticonvulsants
  • Benzodiazepines
  • Ethanol
  • Propofol