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 benzodiazepinesÂ
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)
(day hours) Call or text 510-545-2765, page 510-718-5604
Route chart to AHS Bridge" or email SUN@alamedahealthsystem.org
​Step 5: Bridge Clinic follow up​ as part of the discharge instructions
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Learn more about medication assisted therapy for alcohol use disorder here.