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Treatment of Acute Withdrawal in AUD

Treating withdrawal for stabilization and connecting to longterm treatment

Treatment of Acute Withdrawal in AUD

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Step 0: If patient is pregnant, do not proceed, and contact the SUN team or get Addiction Med consult

Step 1: Always, Always, Always treat acute withdrawal completely

  • Phenobarbital is preferred generally

  • Dose empirically based on severity

  • Generally do not switch to benzodiazepines 

  • For severe cases, consider adjuncts such as dexmedetomidine, valproate, and ketamine

  • For mild cases, consider oral phenobarbital

​Step 2: Prescribe medication for protracted withdrawal.

  • Gabapentin 600 mg TID

  • If severe may start at 1200 mg TID

  • Contraindications:

​Step 3: Prescribe medication to reduce craving and relapse

  • Naltrexone

    • Oral: 25-50 mg  daily

      • Contraindications:

        • Any opioid use (pills, heroin, methadone, buprenorphine)

        • Acute liver injury with AST or ALT >250

      • Alternative: Acamprosate 333mg TID PO

    • Intramuscular extended release eepot: "Vivitrol"

      • For patients with >3 ED visits in last year for alcohol issues

      • Pro tips:

        • Stay up and lateral (away from sitting pressure points), get into the butt muscle

        • It hardens fast; be ready to inject when you mix

        • Discuss with SUN team for any advice or assistance

​Step 4: Contact the Substance Use Navigator (SUN)

​Step 5: Bridge Clinic follow up​ as part of the discharge instructions


Learn more about medication assisted therapy for alcohol use disorder here.

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