Prescribing for Alcohol Withdrawal

If a patient is drinking to an extent which causes problems in terms of physical condition or mental state, if they suffer from withdrawal symptoms and wish to become abstinent, management with the reducing regime of Chlordiazepoxide (Librium) outlined below may be appropriate.  Contra-indications arise where a patient’s consumption is extremely high or where there is a history of fitting, delirium, heart trouble, or deliberate self-harm through overdose.  In these cases medically supervised detoxification is recommended, either by a community-based Community Psychiatric Nurse or in hospital.

The regime recommended by Dr Philip McLean, Consultant Psychiatrist with the Nottingham Alcohol & Drug Team is:

Chlordiazepoxide     20mg TDS for three days

                                    15mg TDS for three days     

10mg TDS for three days

05mg TDS for three days

         + 20mg PRN at first if needed

Vitamin B Compound C, two tablets daily should also be given.

Patients should be warned not to drink whilst they are taking the medication as this can be dangerous. 

Patients should understand and agree to the short-term (detoxification) and long-term goal of intervention, which is normally permanent abstinence.

You may wish to refer patients for subsequent treatment of their psychological dependence.  Please contact apas on the number below for information on this.