>Objective:To review adjunctive treatment options for severe alcohol withdrawal. >Data Sources: The search strategy included a search of Ovid MEDLINE using keywords alcohol withdrawal, severe alcohol withdrawal, AWS, delirium tremens, delirium, dexmedetomidine, propofol, anticonvulsants, clonidine, and phenobarbital and included articles dated from January 1990 to March 2017. >Study Selection and Data Extraction: All English-language clinical trials and case reports assessing the efficacy of adjunctive agents in severe alcohol withdrawal were evaluated. >Data Synthesis: Although first-line pharmacotherapy for alcohol withdrawal continues to be benzodiazepines, literature does not clearly define adjunctive treatment options for severe alcohol withdrawal. During severe alcohol withdrawal patients may become unable to tolerate or may become unresponsive to high-dose benzodiazepines. Large doses of benzodiazepines may also result in oversedation, respiratory insufficiency, and worsening delirium.>Conclusions: Phenobarbital and dexmedetomidine are both viableadjunctive treatment options for severe alcohol withdrawal. Current evidence hasshown these agents decrease the dose requirements of benzodiazepines withlimited incidence of adverse reactions. Propofol may also be a viable option inmechanically ventilated patients, but its lack of clear safety and efficacyadvantages over current treatment options may limit its use in practice.Clonidine, oral anticonvulsants, and ketamine require further controlledclinical trials to clearly define their role in the treatment of severe alcoholwithdrawal.
展开▼
