Medications for Alcohol Use Disorder

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

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ED Treatment

Always, Always, Always treat acute withdrawal completely

• Phenobarbital is preferred generally

• Dose empirically based on severity

• Generally do not administer phenobarbitol and benzodiazepines at the same time

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

• For mild cases, consider oral gabapentin (600-1200 PO)

 

Home Treatment

​Prescribe medication for subacute withdrawal 

(Also prevents craving and reduces relapse)

• Gabapentin 600 mg TID

  • Contraindications: renal failure​

  • 600mg to 1200mg PO TID can also be used for alcohol use disorder treatment and relapse prevention​

  • Contraindicated in those with renal failure

• If severe may start at 1200 mg TID

• Lorazepam or chlordiazepoxide ​can be prescribed if gabapentin intolerance or contraindications exist, or history of *severe* withdrawal seizures

AND 

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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 depot: "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​

 

​Next: Contact the Substance Use Navigator (SUN)

• (day hours) Call or text 510-545-2765

• Epic Chat the Substance Use Navigator group 

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

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