Psychiatry
Alcohol Use Disorder
Psychiatry

Alcohol Use Disorder

Acamprosate, naltrexone, disulfiram; withdrawal management.

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◆Withdrawal management

  • •Benzodiazepines first-line (lorazepam if liver failure)
  • •Thiamine BEFORE glucose (prevent Wernicke)
  • •Mg, folate, multivitamin
  • •DTs: 48–96 hr after last drink; mortality ~5%; ICU + escalating benzos or propofol
  • •Phenobarbital for severe refractory
ScenarioDrug
AUD + liver diseaseAcamprosate
AUD + opioid useAcamprosate
AUD + normal liver, no opioidsNaltrexone
Active alcohol withdrawalBenzodiazepines
Highly motivated + supervisedDisulfiram

High-yield pearls

  • ◆Naltrexone contraindicated with opioids (precipitates withdrawal)
  • ◆Acamprosate is safe with opioids and liver disease
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