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Medications for Alcohol Use Disorder

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

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 

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