How Are Benzodiazepines Used For Alcohol Withdrawal?

Benzodiazepines are the mainstay treatment foralcohol withdrawal because they work on the same GABA receptors in the brain asalcohol, and therefore decrease symptoms of alcohol withdrawal, like headache, tremors, nausea, vomiting, and in some cases,seizures.

How Alcohol And Benzodiazepines Affect The Brain

GABA is an inhibitory neurotransmitter, meaning it slows down neuronal activity in the brain, producing calming effects such as sedation, relaxation, and decreased anxiety.

When the brain becomesdependent on alcohol, the amount of naturally produced GABA is decreased because the brain is now dependent on alcohol to produce it. When alcohol is stopped or greatly reduced, the brain is left with a deficit of naturally occurring GABA.

Without this inhibitory neurotransmitter, the brain immediately enters an over-excitatory state, commonly referred to as rebound hyperexcitability. This can create intense physical and psychological symptoms known as alcohol withdrawal and can be extremely dangerous and even lethal.

Since benzodiazepines also act on the same GABA receptors in the brain to increase a state of calmness, they are administered to dampen or even prevent this phase of hyperexcitability, thereby reducing alcohol withdrawal side effects.

How Benzodiazepines Reduce Alcohol Withdrawal Symptoms

Alcohol withdrawal syndrome (AWS) can be extremely uncomfortable and cause seizures, hallucinations, nightmares, and heart palpitations, among other unpleasant effects. In some cases, alcohol withdrawal can even be fatal.

Many benzodiazepines help reduce the impact of AWS and treat the following symptoms:

• Seizures
• Tremors
• Difficulty sleeping and restlessness
• Nausea and vomiting
• Irritability
• Chills and sweats
• Headaches
• Pain
• Anxiety

Benzodiazepines Used To Treat Alcohol Withdrawal

Benzodiazepines used to treat alcohol withdrawal include:

• Diazepam (Valium)
• Chlordiazepoxide (Librium)
• Lorazepam (Ativan)
• Oxazepam

Long-acting benzodiazepines, such as diazepam and chlordiazepoxide, remain in the body longer because they have long half-lives and active metabolites. This prolonged effect helps provide smoother symptom control and reduces the risk of breakthrough or rebound withdrawal.

However, in patients withliver disease, a common complication of chronic alcohol use, these medications can accumulate and lead to excessive sedation or toxicity because they rely on hepatic metabolism.

Shorter-acting benzodiazepines, such as lorazepam and oxazepam, are preferred for alcohol withdrawal in patients with liver impairment because they are metabolized through glucuronidation, which is less affected by liver dysfunction. Although their shorter duration of action may require more frequent dosing and can allow withdrawal symptoms to re-emerge between doses, this risk is managed by using a scheduled or symptom-triggered taper.

How Are Benzodiazepines Used During Alcohol Withdrawal?

The type of benzodiazepine prescribed and the manner in which it is used will vary depending on several factors, including:

• The severity of the alcohol dependence
• The risk of withdrawal
• The presence of medical conditions, such as liver disease
• The presence of any withdrawal symptoms duringdetox

In general, benzodiazepines are administered in the following ways.

Fixed Tapering Dose Regimen (FTDR)

• Fixed doses are administered in scheduled intervals. Doses are not adjusted based on symptom severity
• Best suited for mild symptoms
• Ideal foroutpatient recovery

Gradually Tapering Regimen (GDR)

• Benzodiazepines are administered according to a predetermined dosing schedule. The dosage is gradually reduced (tapered) until it is discontinued.
• Ideal for outpatient recovery

Symptom Triggered Regimen (STR)

• Dosage is based on the severity of withdrawal symptoms that are assessed by withdrawal rating scales. The assessments are done at a fixed schedule, and the dose of benzodiazepine is administered as per withdrawal severity. Trained personnel are needed to assess withdrawal symptoms and measure the ratings.
• Suited for mild to very severe symptoms
• Can only be utilized under direct medical supervision
• Only used ininpatient recovery.

Loading Dose Regimen (LDR)

• Uses long-acting benzodiazepines that stay in the body for several days
• Most impactful at reducing seizures
• For best results, it should only be used in inpatient settings to allow monitoring

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Are Benzodiazepines Safe?

When taken exactly as prescribed, benzodiazepines are safe and very effective for treating anxiety, insomnia, seizure disorders, and alcohol withdrawal. However, when they are misused, they can become unsafe.

Benzodiazepines are considered a controlled substance due to their potential for misuse. Benzodiazepines are known to create a calming sensation and induce euphoria, and as a result, they are commonly abused.

Benzodiazepine misuse includes:

• Taking benzos any other way than prescribed
• Taking benzos with other drugs or alcohol
• Using someone else’s benzo prescription
• Illicitly purchasing benzos off the street

They have a high risk of dependency and addiction and are classified as aSchedule IV controlled substance.

Side Effects Of Benzodiazepines

Benzodiazepines carry several side effects, including addiction. Additionally, some may cause reactions when used in combination with other alcohol treatment medications.

For these reasons, they should only be taken under the supervision and prescription of a licensed medical professional; an inpatientalcohol detox and rehabilitation setting may be best. However, benzodiazepines are frequently prescribed successfully in outpatient settings as well.

Side effects of benzodiazepines include the following:

• Drowsiness and sedation
• Confusion and lightheadedness
• Nausea and vomiting
• Short-term memory loss
• Poor coordination and balance (fall risk, especially in elderly patients)
• Irritability
• Slurred speech
• Constipation
• Disinhibition

Benefits Of Using Benzodiazepines For Alcohol Withdrawal

Benzodiazepines are the only FDA-approved medication to treat alcohol withdrawal. Alcohol withdrawal can cause seizures and changes in both blood pressure and heart rate, and if not treated, can be deadly. Benzodiazepines can not only prevent these withdrawal side effects but can also prevent and treatdelirium tremens (DTs), which is the most severe form of alcohol withdrawal.

Because benzodiazepines work on the same GABA receptors in the brain as alcohol, and hence why both alcohol and benzodiazepines are known asCNS depressants, benzodiazepines can replace alcohol to curb withdrawal side effects under medical supervision

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How Do I Get Benzodiazepines For Alcohol Withdrawal Treatment?

Benzodiazepines are prescription medications, so you must speak with your doctor about your alcohol use and risk of withdrawal if you are considering stopping alcohol or drastically cutting back.

Your doctor will discuss your alcohol intake and medical history and come up with a treatment plan for detox, which may involve benzodiazepines. If you are prescribed benzodiazepines for alcohol detox, it is important to take this medication as prescribed.

Find A Treatment Center Today

Alcoholism is a very serious disorder, and it can be difficult to overcome alone. This is especially true during alcohol withdrawal, a potentially dangerous time that should be monitored by medical professionals.

If you or a loved one is struggling to overcome alcoholism, help is available.Contact a treatment provider or visit ourrehab directory to explore youralcohol addiction treatment options.