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TOX TIME: Alcohol Withdrawal

Laura Roper MD and Mike Weinstock, MD
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18:43
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No me gusta!

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Laura and Mike discuss alcohol withdrawal syndrome, and how urgent care providers can help prevent injury and death due to complicated AWS.

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Lisa W. -

Quick question - as I was listening I tried to jot down the Librium schedule. I wanted to clarify - on day 5, does the symptom triggered scheduling return to q6h? On Day 4 Dr. Roper had the symptom triggered scheduling as q12h so I wondered why it increased to q6h on day 5? Thanks for clarifying.

Mike W., MD -

From Laura Roper:
hank you for your comment. Benzodiazepines can be administered using a 5 day fixed-dose or symptom-triggered schedule. Chlordiazepoxide (Librium) was recommended because it is a long-acting benzodiazepine and has less abuse potential. With a fixed-dose schedule, a specific dosage is given at specific intervals, regardless of the patient's symptoms. With a symptom-triggered schedule, medication is administered only when the patient has significant symptoms of CIWA-Ar score greater than 9.
The recommended symptom-triggered Librium schedule is as follows: Day 1: 25-50 mg every 4 hours PRN for CIWA greater than 9, Day 2: 25-50 mg every 6 hours PRN, Day 3: 25-50 mg every 6 hours PRN, Day 4: 25-50 mg every 12 hours PRN, Day 5: 25-50 mg every 12 hours PRN
The paper referenced in the podcast for the outpatient regimen lists chlordiazepoxide as going back up to every 6 hours on the 5th day of symptom-triggered treatment. This is likely a typo as other references recommend every 12 hours PRN on Day 5 as you suggested. I apologize for perpetuating the error and any confusion it caused. The Librium schedule written out above is correct!
Here is the reference cited for the dosing schedule if you want more information about outpatient treatment regimens for mild/uncomplicated alcohol withdrawal: Herbert L. Muncie, J., Yasinian, Y., & Oge', L. (2013, November 01). Outpatient Management of Alcohol Withdrawal Syndrome. Retrieved November 11, 2020, from https://www.aafp.org/afp/2013/1101/p589.html

Christina K. -

Thanks for the clarification! I had the same question too after I jotted down the symptoms-based scheduling.

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Urgent Care Rap November 2020 Written Summary 269 KB - PDF

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