Skip to main content
Log in

Managing Alcohol Withdrawal in the Elderly

  • Disease Management
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

The alcohol withdrawal syndrome is common in elderly individuals who are alcohol dependent and who decrease or stop their alcohol intake. While there have been few clinical studies to directly support or refute the hypothesis that withdrawal symptom severity, delirium and seizures increase with advancing age, several observational studies suggest that adverse functional and cognitive complications during alcohol withdrawal do occur more frequently in elderly patients. Most elderly patients with alcohol withdrawal symptoms should be considered for admission to an inpatient setting for supportive care and management. However, elderly patients with adequate social support and without significant withdrawal symptoms at presentation, comorbid illness or past history of complicated withdrawal may be suitable for outpatient management.

Although over 100 drugs have been described for alcohol withdrawal treatment, there have been no studies assessing the efficacy of these drugs specifically in elderly patients. Studies in younger patients support benzodiazepines as the most efficacious therapy for reducing withdrawal symptoms and the incidence of delirium and seizure. While short-acting benzodiazepines, such as oxazepam and lorazepam, may be appropriate for elderly patients given the risk for excessive sedation from long-acting benzodiazepines, they may be less effective in preventing seizures and more prone to produce discontinuation symptoms if not tapered properly. To ensure appropriate benzodiazepine treatment, dose and frequency should be individualised with frequent monitoring, and based on validated alcohol withdrawal severity measures. Selected patients who have a history of severe or complicated withdrawal symptoms may benefit from a fixed schedule of benzodiazepine provided that medication is held for sedation. β-Blockers, clonidine, carbamazepine and haloperidol may be used as adjunctive agents to treat symptoms not controlled by benzodiazepines. Lastly, the age of the patient should not deter clinicians from helping the patient achieve successful alcohol treatment and rehabilitation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Reid MC, Anderson PA. Geriatric substance use disorders. Med Clin North Am 1997; 81(4): 999–1016

    PubMed  CAS  Google Scholar 

  2. Fink A, Hays RD, Moore AA, et al. Alcohol-related problems in older persons. Determinants, consequences, and screening. Arch Intern Med 1996; 156(11): 1150–6

    PubMed  CAS  Google Scholar 

  3. Council on Scientific Affairs. Alcoholism in the elderly: council report. JAMA 1996; 275(10): 797–801

    Google Scholar 

  4. Schuckit MA. Clinical review of alcohol, alcoholism, and the elderly patient. J Clin Psychiatry 1982; 43: 396–9

    PubMed  CAS  Google Scholar 

  5. Atkinson RM. Aging and alcohol use disorders: diagnostic issues in the elderly. Int Psychogeriatr 1990; 2: 55–72

    PubMed  CAS  Google Scholar 

  6. Finlayson RE, Hurt RD, Davis Jr LJ, et al. Alcoholism in elderly persons: a study of the psychiatric and psychosocial features of 216 inpatients. Mayo Clin Proc 1988; 63(8): 761–8

    PubMed  CAS  Google Scholar 

  7. Beresford TP, Beresford T, Gomberg E, editors. Alcohol and aging. New York: Oxford University Press, 1995

    Google Scholar 

  8. Hurt RD, Finlayson RE, Morse RM, et al. Alcoholism in elderly persons: medical aspects and prognosis of 216 inpatients. Mayo Clin Proc 1988; 63(8): 753–60

    PubMed  CAS  Google Scholar 

  9. Grant BE. Alcohol consumption, alcohol abuse and alcohol dependence: the United States as an example. Addiction 1994; 89(11): 1357–65

    PubMed  CAS  Google Scholar 

  10. Williams GD, DeBakey SF. Changes in levels of alcohol consumption: United States, 1983–1988. Br J Addict 1992; 87: 643–8

    PubMed  CAS  Google Scholar 

  11. Adams WL, Magruder-Habib K, Trued S, et al. Alcohol abuse in elderly emergency department patients. J Am Geriatr Soc 1992; 40(12): 1236–40

    PubMed  CAS  Google Scholar 

  12. Buchsbaum DG, Buchanan RG, Lawton MJ, et al. Alcohol consumption patterns in a primary care population. Alcohol Alcohol 1991; 26(2): 215–20

    PubMed  CAS  Google Scholar 

  13. Curtis JR, Geller G, Stokes EJ, et al. Characteristics, diagnosis, and treatment of alcoholism in elderly patients. J Am Geriatr Soc 1989; 37(4): 310–6

    PubMed  CAS  Google Scholar 

  14. Liberto JG, Oslin DW, Ruskin PE. Alcoholism in older persons: a review of the literature. Hosp Community Psychiatry 1992; 43(10): 975–84

    PubMed  CAS  Google Scholar 

  15. Magruder-Habib K, Saltz CC, Barron PM. Age-related patterns of alcoholism among veterans in ambulatory care. Hosp Community Psychiatry 1986; 37(12): 1251–5

    PubMed  CAS  Google Scholar 

  16. Mangion DM, Platt JS, Syam V. Alcohol and acute medical admission of elderly people. Age Ageing 1992; 21(5): 362–7

    PubMed  CAS  Google Scholar 

  17. Schuckit MA, Miller PL. Alcoholism in elderly men: a survey of a general medical ward. Ann N Y Acad Sci 1975; 275: 558–71

    Google Scholar 

  18. Simon A, Epstein LJ, Reynolds L. Alcoholism in the geriatric mentally ill. Geriatrics 1968; 23(10): 125–31

    PubMed  CAS  Google Scholar 

  19. Gaitz CM, Baer PE. Characteristics of elderly persons with alcoholism. Arch Gen Psychiatry 1971; 24: 372–8

    PubMed  CAS  Google Scholar 

  20. Tabisz E, Badger M, Meatherall R, et al. Identification of chemical abuse in the elderly admitted to emergency rooms. Clin Gerontol 1991; 11: 27–38

    Google Scholar 

  21. Adams WL, Yuan Z, Barboriak JJ, et al. Alcohol-related hospitalizations of elderly people: prevalence and geographic variation in the United States [published erratum appears in JAMA 1993 Nov 3; 270 (17): 2055]. JAMA 1993; 270(10): 1222–5

    PubMed  CAS  Google Scholar 

  22. Kraemer KL, Mayo-Smith MF, Calkins DR. Impact of age on the severity, course, and complications of alcohol withdrawal. Arch Intern Med 1997; 157(19): 2234–41

    PubMed  CAS  Google Scholar 

  23. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994

    Google Scholar 

  24. Whitfield CL, Thompson G, Lamb A, et al. Detoxification of 1,024 alcoholic patients without psychoactive drugs. JAMA 1978; 239: 1409–10

    PubMed  CAS  Google Scholar 

  25. Benzer DG. Quantification of the alcohol withdrawal syndrome in 487 alcoholic patients. J Subst Abuse Treat 1990; 7(2): 117–23

    PubMed  CAS  Google Scholar 

  26. Liskow BI, Rinck C, Campbell J, et al. Alcohol withdrawal in the elderly. J Stud Alcohol 1989; 50(5): 414–21

    PubMed  CAS  Google Scholar 

  27. Brower KJ, Mudd S, Blow FC, et al. Severity and treatment of alcohol withdrawal in elderly versus younger patients. Alcohol Clin Exp Res 1994; 18(1): 196–201

    PubMed  CAS  Google Scholar 

  28. Linnoila M. Alcohol withdrawal and noradrenergic function. Ann Intern Med 1987; 107: 875–89

    PubMed  CAS  Google Scholar 

  29. Sellers EM, Zilm DH, Degani NC. Comparative efficacy of propranolol and chlordiazepoxide in alcohol withdrawal. J Stud Alcohol 1977; 38(11): 2096–108

    PubMed  CAS  Google Scholar 

  30. Worner TM. Propranolol versus diazepam in the management of the alcohol withdrawal syndrome: double-blind controlled trial. Am J Drug Alcohol Abuse 1994; 20(1): 115–24

    PubMed  CAS  Google Scholar 

  31. Kraus ML, Gottlieb LD, Horwitz RI, et al. Randomized clinical trial of atenolol in patients with alcohol withdrawal. N Engl J Med 1985; 313(15): 905–9

    PubMed  CAS  Google Scholar 

  32. Zilm DH, Jacob MS, MacLeod SM, et al. Propranolol and chlordiazepoxide effects on cardiac arrhythmias during alcohol withdrawal. Alcohol Clin Exp Res 1980; 4(4): 400–5

    PubMed  CAS  Google Scholar 

  33. Bjorkqvist SE. Clonidine in alcohol withdrawal. Acta Psychiatr Scand 1975; 52(4): 256–63

    PubMed  CAS  Google Scholar 

  34. Wilkins AJ, Jenkins WJ, Steiner JA. Efficacy of clonidine in treatment of the alcohol withdrawal state. Psychopharmacology 1983; 81(1): 78–80

    PubMed  CAS  Google Scholar 

  35. Manhem P, Nilsson LH, Moberg AL, et al. Alcohol withdrawal: effects of clonidine treatment on sympathetic activity, the renin-aldosterone system, and clinical symptoms. Alcohol Clin Exp Res 1985; 9(3): 238–43

    PubMed  CAS  Google Scholar 

  36. Baumgartner GR, Rowen RC. Clonidine vs chlordiazepoxide in the management of acute alcohol withdrawal syndrome. Arch Intern Med 1987; 147(7): 1223–6

    PubMed  CAS  Google Scholar 

  37. Cushman Jr P, Sowers JR. Alcohol withdrawal syndrome: clinical and hormonal responses to alpha 2-adrenergic agonist treatment. Alcohol Clin Exp Res 1989; 13(3): 361–4

    PubMed  Google Scholar 

  38. Robinson BJ, Robinson GM, Maling TJ, et al. Is clonidine useful in the treatment of alcohol withdrawal? Alcohol Clin Exp Res 1989; 13(1): 95–8

    PubMed  CAS  Google Scholar 

  39. Baumgartner GR, Rowen RC. Transdermal clonidine versus chlordiazepoxide in alcohol withdrawal: a randomized, controlled clinical trial. South Med J 1991; 84(3): 312–21

    PubMed  CAS  Google Scholar 

  40. Ticku MK. Alcohol and GAB A-benzodiazepine receptor function. Ann Med 1990; 22: 241–6

    PubMed  CAS  Google Scholar 

  41. Gorelick DA. Recent developments in alcoholism: pharmacological treatment. Recent Dev Alcohol 1993; 11: 413–27

    PubMed  CAS  Google Scholar 

  42. Tsai G, Gastfriend DR, Coyle JT. The glutamatergic basis of human alcoholism. Am J Psychiatry 1995; 152(3): 332–40

    PubMed  CAS  Google Scholar 

  43. Freund G, Anderson KJ. Glutamate receptors in the frontal cortex of alcoholics. Alcohol Clin Exp Res 1996; 20: 1165–72

    PubMed  CAS  Google Scholar 

  44. Ballenger JC, Post RM. Kindling as a model for alcohol withdrawal syndromes. Br J Psychiatry 1978; 133: 1–14

    PubMed  CAS  Google Scholar 

  45. Lechtenberg R, Worner TM. Seizure risk with recurrent alcohol detoxification. Arch Neurol 1990; 47: 535–8

    PubMed  CAS  Google Scholar 

  46. Brown ME, Anton RF, Malcolm R, et al. Alcohol detoxification and withdrawal seizures: clinical support for a kindling hypothesis. Biol Psychiatry 1988; 23(5): 507–14

    PubMed  CAS  Google Scholar 

  47. Booth BM, Blow FC. The kindling hypothesis: further evidence from a US national study of alcoholic men. Alcohol Alcohol 1993; 28(5): 593–8

    PubMed  CAS  Google Scholar 

  48. Lechtenberg R, Worner TM. Relative kindling effect of detoxification and non-detoxification admissions in alcoholics. Alcohol Alcohol 1991; 26(2): 221–5

    PubMed  CAS  Google Scholar 

  49. Foy A, Kay J, Taylor A. The course of alcohol withdrawal in a general hospital. Q J Med 1997; 90(4): 253–61

    CAS  Google Scholar 

  50. Isbell H, Fraser HF, Wikler A, et al. An experimental study of the etiology of ‘rum fits’ and delirium tremens. Q J Stud Alcohol 1955; 16: 1–33

    PubMed  CAS  Google Scholar 

  51. Pristach CA, Smith CM, Whitney RB. Alcohol withdrawal syndromes: prediction from detailed medical and drinking histories. Drug Alcohol Depend 1983; 11(2): 177–99

    PubMed  CAS  Google Scholar 

  52. Ferguson JA, Suelzer CJ, Eckert GJ, et al. Risk factors for delirium tremens development. J Gen Intern Med 1996; 11(7): 410–4

    PubMed  CAS  Google Scholar 

  53. Schuckit MA, Tipp JE, Reich T, et al. The histories of withdrawal convulsions and delirium tremens in 1648 alcohol dependent subjects. Addiction 1995; 90: 1335–47

    PubMed  CAS  Google Scholar 

  54. Wetterling T, Kanitz RD, Veltrup C, et al. Clinical predictors of alcohol withdrawal delirium. Alcohol Clin Exp Res 1994; 18(5): 1100–2

    PubMed  CAS  Google Scholar 

  55. Vinson DC, Menezes M. Admission alcohol level: a predictor of the course of alcohol withdrawal. J Fam Pract 1991; 33(2): 161–7

    PubMed  CAS  Google Scholar 

  56. Foy A, March S, Drinkwater V. Use of an objective clinical scale in the assessment and management of alcohol withdrawal in a large general hospital. Alcohol Clin Exp Res 1988; 12(3): 360–4

    PubMed  CAS  Google Scholar 

  57. Victor M, Adams RD. The effect of alcohol on the nervous system. Res Publ Assoc Res Nerv Ment Dis 1953; 32: 526–73

    PubMed  CAS  Google Scholar 

  58. Morton AW, Laird LK, Crane DF, et al. A prediction model for identifying alcohol withdrawal seizures. Am J Drug Alcohol Abuse 1994; 20: 75–86

    PubMed  CAS  Google Scholar 

  59. Metcalfe P, Sobers M, Dewey M. The Windsor clinic alcohol withdrawal assessment scale (WCAWAS): investigation of factors associated with complicated withdrawals. Alcohol Alcohol 1995; 30(3): 367–72

    PubMed  CAS  Google Scholar 

  60. Fiellin DA, Samet JH, O’Connor PG. Reducing bias in observational research on alcohol withdrawal syndrome. Subst Abuse 1998; 19: 23–31

    Google Scholar 

  61. Shaw JM, Kolesar GS, Sellers EM, et al. Development of optimal treatment tactics for alcohol withdrawal: I. Assessment and effectiveness of supportive care. J Clin Psychopharmacol 1981; 1(6): 382–7

    PubMed  CAS  Google Scholar 

  62. Sullivan JT, Sykora K, Schneiderman J, et al. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict 1989; 84(11): 1353–7

    PubMed  CAS  Google Scholar 

  63. Sullivan JT, Swift RM, Lewis DC. Benzodiazepine requirements during alcohol withdrawal syndrome: clinical implications of using a standardized withdrawal scale. J Clin Psychopharmacol 1991; 11(5): 291–5

    PubMed  CAS  Google Scholar 

  64. Salloum IM, Cornelius JR, Daley DC, et al. The utility of diazepam loading in the treatment of alcohol withdrawal among psychiatric inpatients. Psychopharmacol Bull 1995; 31(2): 305–10

    PubMed  CAS  Google Scholar 

  65. Wartenberg AA, Nirenberg TD, Liepman MR, et al. Detoxification of alcoholics: improving care by symptom-triggered sedation. Alcohol Clin Exp Res 1990; 14(1): 71–5

    PubMed  CAS  Google Scholar 

  66. Saitz R, Mayo-Smith MF, Roberts MS, et al. Individualized treatment for alcohol withdrawal: a randomized double-blind controlled trial. JAMA 1994; 272(7): 519–23

    PubMed  CAS  Google Scholar 

  67. Hayashida M, Alterman AI, McLellan AT, et al. Comparative effectiveness and costs of inpatient and outpatient detoxification of patients with mild-to-moderate alcohol withdrawal syndrome. N Engl J Med 1989; 320(6): 358–65

    PubMed  CAS  Google Scholar 

  68. Sparadeo FR, Zwick WR, Ruggiero SD, et al. Evaluation of a social-setting detoxication program. J Stud Alcohol 1982; 43(11): 1124–36

    PubMed  CAS  Google Scholar 

  69. O’Connor PG, Gottlieb LD, Kraus ML, et al. Social and clinical features as predictors of outcome in outpatient alcohol withdrawal. J Gen Intern Med 1991; 6(4): 312–6

    PubMed  Google Scholar 

  70. Feldman DJ, Pattison EM, Sobell LC, et al. Outpatient alcohol detoxification: initial findings on 564 patients. Am J Psychiatry 1975; 132: 407–12

    PubMed  CAS  Google Scholar 

  71. Stockwell T, Bolt L, Milner I, et al. Home detoxification from alcohol: its safety and efficacy in comparison with inpatient care. Alcohol Alcohol 1991; 26(5–6): 645–50

    PubMed  CAS  Google Scholar 

  72. Evans DJ, Street SD, Lynch DJ. Alcohol withdrawal at home: pilot project for frail elderly people. Can Fam Physician 1996; 42: 937–45

    PubMed  CAS  Google Scholar 

  73. Naranjo CA, Sellers EM, Chater K, et al. Nonpharmacologic intervention in acute alcohol withdrawal. Clin Pharmacol Ther 1983; 34(2): 214–9

    PubMed  CAS  Google Scholar 

  74. Sellers EM, Naranjo CA, Harrison M, et al. Diazepam loading: simplified treatment of alcohol withdrawal. Clin Pharmacol Ther 1983; 34(6): 822–6

    PubMed  CAS  Google Scholar 

  75. Levkoff SE, Marcantonio ER. Delirium: a major diagnostic and therapeutic challenge for clinicians caring for the elderly. Compr Ther 1994; 20: 550–7

    PubMed  CAS  Google Scholar 

  76. Mayo-Smith MF. Pharmacological management of alcohol withdrawal: a meta-analysis and evidence-based practice guideline. JAMA 1997; 278(2): 144–51

    PubMed  CAS  Google Scholar 

  77. Saitz R, O’Malley SS. Pharmacotherapies for alcohol abuse: withdrawal and treatment. Med Clin North Am 1997; 81(4): 881–907

    PubMed  CAS  Google Scholar 

  78. Sellers EM, Kalant H. Alcohol intoxication and withdrawal. N Eng J Med 1976; 294: 757–62

    Google Scholar 

  79. Turner RC, Lichstein PR, Peden Jr JG, et al. Alcohol withdrawal syndromes: a review of pathophysiology, clinical presentation, and treatment. J Gen Intern Med 1989; 4(5): 432–44

    PubMed  CAS  Google Scholar 

  80. Saitz R, Friedman LS, Mayo-Smith ME. Alcohol withdrawal: a nationwide survey of inpatient treatment practices. J Gen Intern Med 1995; 10(9): 479–87

    PubMed  CAS  Google Scholar 

  81. Institute of Medicine. Prevention and treatment of alcohol problems. Washington, DC: National Academy Press, 1990: 268

    Google Scholar 

  82. Rosenfeld JE, Bizzoco DH. A controlled study of alcohol withdrawal. Q J Stud Alcohol 1961; 1: 77–84

    PubMed  Google Scholar 

  83. Sereny G, Kalant H. Comparative clinical evaluation of chlordiazepoxide and promazine in treatment of alcohol withdrawal syndrome. BMJ 1965; 1: 92–7

    PubMed  CAS  Google Scholar 

  84. Kaim SC, Klett CJ, Rothfeld B. Treatment of the acute alcohol withdrawal state: a comparison of four drugs. Am J Psychiatry 1969; 125(12): 1640–6

    PubMed  CAS  Google Scholar 

  85. Greenblatt DJ, Shader RI, Abernethy DR. Drugtherapy: current status of benzodiazepines. N Engl J Med 1983; 309(7): 410–6

    PubMed  CAS  Google Scholar 

  86. Peppers MP. Benzodiazepines for alcohol withdrawal in the elderly and in patients with liver disease. Pharmacotherapy 1996; 16(1): 49–57

    PubMed  CAS  Google Scholar 

  87. Meyer BR. Benzodiazepines in the elderly. Med Clin North Am 1982; 66(5): 1017–35

    PubMed  CAS  Google Scholar 

  88. American Psychiatric Association. Task force on benzodiazepine dependency: benzodiazepine dependence, toxicity and abuse. Washington, DC: American Psychiatric Association, 1990

    Google Scholar 

  89. Shader RI, Greenblatt DJ, Harmatz JS, et al. Absorption and disposition of chlordiazepoxide in young and elderly male volunteers. J Clin Pharmacol 1977; 17: 709–18

    PubMed  CAS  Google Scholar 

  90. MacLeod SM, Giles HG, Bengert B, et al. Age and gender related differences in diazepam pharmacokinetics. J Clin Pharmacol 1979; 19: 15–9

    PubMed  CAS  Google Scholar 

  91. Greenblatt DJ, Allen MD, Harmatz JS, et al. Diazepam disposition determinants. Clin Pharmacol Ther 1980; 27: 301–12

    PubMed  CAS  Google Scholar 

  92. Roberts RK, Wilkinson GR, Branch RA, et al. Effects of age and parenchymal liver disease on the disposition of chlordiazepoxide (librium). Gastroenterology 1978; 75: 479–85

    PubMed  CAS  Google Scholar 

  93. Macklon AF, Barton M, James O, et al. The effect of age on the pharmacokinetics of diazepam. Clin Sci 1980; 59: 479–83

    PubMed  CAS  Google Scholar 

  94. Allen MD, Greenblatt DJ, Harmatz JS, et al. Desmethyldiazepam kinetics in the elderly after prazepam. Clin Pharmacol Ther 1980; 28: 196–202

    PubMed  CAS  Google Scholar 

  95. Klotz U, Muller-Seydlitz P. Altered elimination of desmethyldiazepam in the elderly. Br J Clin Pharmacol 1979; 7: 119–20

    PubMed  CAS  Google Scholar 

  96. Greenblatt DJ, Allen MD, Locniskar A, et al. Lorazepam kinetics in the elderly. Clin Pharmacol Ther 1979; 26: 103–13

    PubMed  CAS  Google Scholar 

  97. Kraus JW, Desmond PU, Marshall JP, et al. Effects of aging and liver disease on disposition of lorazepam. Clin Pharmacol Ther 1978; 24: 411–9

    PubMed  CAS  Google Scholar 

  98. Murray TG, Chiang ST, Koepke HH, et al. Renal disease, age, and oxazepam kinetics. Clin Pharmacol Ther 1981; 30: 805–9

    PubMed  CAS  Google Scholar 

  99. Greenblatt DJ, Divoll M, Harmatz JS, et al. Oxazepam kinetics: effects of age and sex. J Pharmacol Exp Ther 1980; 215: 86–91

    PubMed  CAS  Google Scholar 

  100. Salzman C, Shader RI, Greenblatt DJ, et al. Long versus short half-life benzodiazepines in the elderly: kinetics and clinical effects of diazepam and oxazepam. Arch Gen Psychiatry 1983; 40: 293–7

    PubMed  CAS  Google Scholar 

  101. Castledon CM, George CF, Marcer D, et al. Increased sensitivity to nitrazepam in old age. BMJ 1977; 1: 10–2

    Google Scholar 

  102. Healy M, Pickens R, Meisch R, et al. Effects of clorazapate, diazepam, lorazepam, and placebo on human memory. J Clin Psychiatry 1983; 44: 436–9

    Google Scholar 

  103. Gottshalk L. Affective and cognitive problems with benzodiazepines. J Clin Psychopharmacol 1988; 8: 223–5

    Google Scholar 

  104. Reidenberg MM, Levy M, Warner H, et al. Relationship between diazepam dose, plasma level, age, and central nervous system depression. Clin Pharmacol Ther 1978; 23: 371–4

    PubMed  CAS  Google Scholar 

  105. Giles HG, MacLeod SM, Wright JR, et al. Influence of age and previous use on diazepam dosage required for endoscopy. Can Med Assoc J 1978; 118: 513–4

    PubMed  CAS  Google Scholar 

  106. Ritson B, Chick J. Comparison of two benzodiazepines in the treatment of alcohol withdrawal: effects on symptoms and cognitive recovery. Drug Alcohol Depend 1986; 18(4): 329–34

    PubMed  CAS  Google Scholar 

  107. Shader RI, Greenblatt DJ. Use of benzodiazepines in anxiety disorders. N Engl J Med 1993; 328(19): 1398–405

    PubMed  CAS  Google Scholar 

  108. Wilson A, Vulcano BA. Double-blind trial of alprazolam and chlordiazepoxide in the management of the acute ethanol withdrawal syndrome. Alcohol Clin Exp Res 1985; 9(1): 23–7

    PubMed  CAS  Google Scholar 

  109. Mayo-Smith MF, Bernard D. Late-onset seizures in alcohol withdrawal. Alcohol Clin Exp Res 1995; 19(3): 656–9

    PubMed  CAS  Google Scholar 

  110. Solomon K, Manepalli J, Ireland GA, et al. Alcoholism and prescription drug abuse in the elderly: St Louis University grand rounds [clinical conference]. J Am Geriatric Soc 1993; 41(1): 57–69

    CAS  Google Scholar 

  111. Hill A, Williams D. Hazards associated with the use of benzodiazepines in alcohol detoxification. J Subst Abuse Treat 1993; 10(5): 449–51

    PubMed  CAS  Google Scholar 

  112. Bird RD, Makela EH. Alcohol withdrawal: what is the benzodiazepine of choice? Ann Pharmacother 1994; 28(1): 67–71

    PubMed  CAS  Google Scholar 

  113. Ayd FJ. Oxazepam: update 1989. Int Clin Psychopharmacol 1991; 5: 1–15

    Google Scholar 

  114. Heinala P, Piepponen T, Heikkinen H. Diazepam loading in alcohol withdrawal: clinical pharmacokinetics. Int J Clin Pharmacol Ther Toxicol 1990; 28(5): 211–7

    PubMed  CAS  Google Scholar 

  115. Wadstein J, Manhem P, Nilsson LH, et al. Clonidine versus chlormethiazole in alcohol withdrawal. Acta Psychiatr Scand 1986; 327 Suppl.: 144–8

    CAS  Google Scholar 

  116. Jacob MS, Zilm DH, MacLeod SM, et al. Propranolol-associated confused states during alcohol withdrawal. J Clin Psychopharmacol 1983; 3(3): 185–7

    PubMed  CAS  Google Scholar 

  117. Kuhr BM. Prolonged delirium with propanolol. J Clin Psychiatry 1979; 40(4): 198–9

    PubMed  CAS  Google Scholar 

  118. Zechnich RJ. Beta blockers can obscure diagnosis of delirium tremens [letter]. Lancet 1982; I(8280): 1071–2

    Google Scholar 

  119. Kramp P, Rafaelsen OJ. Delirium tremens: a double-blind comparison of diazepam and barbital treatment. Acta Psychiatr Scand 1978; 58(2): 174–90

    PubMed  CAS  Google Scholar 

  120. Bernus I, Dickinson RG, Hooper WD, et al. Anticonvulsant therapy in aged patients: clinical pharmacokinetic considerations. Drugs Aging 1997; 10: 278–89

    PubMed  CAS  Google Scholar 

  121. Mendelson JH, Ogata M, Mello NK. Effects of alcohol ingestion and withdrawal on magnesium states of alcoholics: clinical and experimental findings. Ann N Y Acad Sci 1969; 162: 918–33

    PubMed  CAS  Google Scholar 

  122. Wacker WEC, Parisi AF. Magnesium metabolism. N Eng J Med 1968; 278: 658–63

    CAS  Google Scholar 

  123. Dirks JH. The kidney and magnesium regulation. Kidney Int 1983; 23: 771–7

    PubMed  CAS  Google Scholar 

  124. Kramp P, Hemmingsen R, Rafaelsen OJ. Magnesium concentrations in blood and cerebrospinal fluid during delirium tremens. Psychiatry Res 1979; 1(2): 161–71

    PubMed  CAS  Google Scholar 

  125. Ragland G. Electrolyte abnormalities in the alcoholic patient. Emerg Med Clin North Am 1990; 8(4): 761–73

    PubMed  CAS  Google Scholar 

  126. Wilson A, Vulcano BA. A double-blind, placebo-controlled trial of magnesium sulfate in the ethanol withdrawal syndrome. Alcohol Clin Exp Res 1984; 8: 542–5

    PubMed  CAS  Google Scholar 

  127. Denison H, Jern S, Jagenburg R, et al. Influence of increased adrenergic activity and magnesium depletion on cardiac rhythm in alcohol withdrawal. Br Heart J 1994; 72(6): 554–60

    PubMed  CAS  Google Scholar 

  128. Victor M, Adams RC, Collins GH. The Wernicke-Korsakoff syndrome and related neurological disorders due to alcoholism and malnutrition. Philadelphia: FA Davis, 1989

    Google Scholar 

  129. Harper C. Wernicke’s encephalopathy: a more common disease than realised: a neuropathological study of 51 cases. J Neurol Neurosurg Psychiatry 1979; 42(3): 226–31

    PubMed  CAS  Google Scholar 

  130. Bjorkqvist SE, Isohanni M, Makela R, et al. Ambulant treatment of alcohol withdrawal symptoms with carbamazepine: a formal multicentre double-blind comparison with placebo. Acta Psychiatr Scand 1976; 53(5): 333–42

    PubMed  CAS  Google Scholar 

  131. Flygenring J, Hansen J, Holst B, et al. Treatment of alcohol withdrawal symptoms in hospitalized patients: a randomized, double-blind comparison of carbamazepine (Tegretol) and barbital (Diemal). Acta Psychiatr Scand 1984; 69(5): 398–408

    PubMed  CAS  Google Scholar 

  132. Malcolm R, Ballenger JC, Sturgis ET, et al. Double-blind controlled trial comparing carbamazepine to oxazepam treatment of alcohol withdrawal. Am J Psychiatry 1989; 146(5): 617–21

    PubMed  CAS  Google Scholar 

  133. Stuppaeck CH, Pycha R, Miller C, et al. Carbamazepine versus oxazepam in the treatment of alcohol withdrawal: a double-blind study. Alcohol Alcohol 1992; 27(2): 153–8

    PubMed  CAS  Google Scholar 

  134. Chu NS. Carbamazepine: prevention of alcohol withdrawal seizures. Neurology 1979; 29(10): 1397–401

    PubMed  CAS  Google Scholar 

  135. Racine R. Kindling: the first decade. Neurosurgery 1978; 3(2): 234–52

    PubMed  CAS  Google Scholar 

  136. Bowman EH, Thimann J. Treatment of alcoholism in the sub-acute stage: a study of three active agents. Dis Nerv Syst 1966; 27(5): 342–6

    PubMed  CAS  Google Scholar 

  137. Palestine ML, Alatorre E. Control of acute alcoholic withdrawal symptoms: a comparative study of haloperidol and chlordiazepoxide. Curr Ther Res Clin Exp 1976; 20(3): 289–99

    PubMed  CAS  Google Scholar 

  138. Thomas DW, Freedman DX. Treatment of the alcohol withdrawal syndrome: comparison of promazine and paraldehyde. JAMA 1964; 188: 244–6

    Google Scholar 

  139. Chambers JF, Schultz JD. Double-blind study of three drugs in the treatment of acute alcoholic states. Q J Stud Alcohol 1965; 26: 10–18

    PubMed  CAS  Google Scholar 

  140. Blum K, Eubanks JD, Wallace JE, et al. Enhancement of alcohol withdrawal convulsions in mice by haloperidol. Clin Toxicol 1976; 9: 427–34

    PubMed  CAS  Google Scholar 

  141. Thompson WL, Johnson AD, Maddrey WL. Diazepam and par-aldehyde for treatment of severe delirium tremens: a controlled trial. Ann Intern Med 1975; 82(2): 175–80

    PubMed  CAS  Google Scholar 

  142. Golbert TM, Sanz CJ, Rose HD, et al. Comparative evaluation of treatments of alcohol withdrawal syndromes. JAMA 1967; 201(2): 99–102

    PubMed  CAS  Google Scholar 

  143. Morgan MY. The management of alcohol withdrawal using chlormethiazole. Alcohol Alcohol 1995; 30(6): 771–4

    PubMed  CAS  Google Scholar 

  144. Fulton B, Park GR. Intravenous chlormethiazole. Br J Hosp Med 1992; 48(11): 742–7

    PubMed  CAS  Google Scholar 

  145. Spies CD, Dubisz N, Funk W, et al. Prophylaxis of alcohol withdrawal syndrome in alcohol-dependent patients admitted to the intensive care unit after tumour resection. Br J Anaesth 1995; 75(6): 734–9

    PubMed  CAS  Google Scholar 

  146. Gillman MA, Lichtigfeld FJ. The drug management of severe alcohol withdrawal syndrome. Postgrad Med J 1991; 66: 1005–9

    Google Scholar 

  147. Tubridy P. Alprazolam versus chlormethiazole in acute alcohol withdrawal. Br J Addict 1988; 83(5): 581–5

    PubMed  CAS  Google Scholar 

  148. Palsson A. The efficacy of early chlormethiazole medication in the prevention of delirium tremens. Acta Psychiatr Scand 1986; 329 Suppl.: 140–5

    CAS  Google Scholar 

  149. Burroughs AK, Morgan MY, Sherlock S. Double-blind controlled trial of bromocriptine, chlordiazepoxide and chlormethiazole for alcohol withdrawal symptoms. Alcohol Alcohol 1985; 20(3): 263–71

    PubMed  CAS  Google Scholar 

  150. Lapierre YD, Buhner DR, Oyewumi LK, et al. Comparison of chlormethiazole and chlordiazepoxide in the treatment of acute alcohol withdrawal. Neuropsychobiology 1983; 10: 127–30

    PubMed  CAS  Google Scholar 

  151. Frecker RC, Shaw JM, Zilm DH, et al. Nonpharmacological supportive care compared to chlormethiazole infusion in the management of severe acute alcohol withdrawal. J Clin Psychopharmacol 1982; 2(4): 277–80

    PubMed  CAS  Google Scholar 

  152. Ritola E, Malinen L. A double-blind comparison of carbamazepine and chlormethiazole in the treatment of alcohol withdrawal syndrome. Acta Psychiatr Scand 1981; 64: 254–9

    PubMed  CAS  Google Scholar 

  153. Madden JS, Jones D, Frisch ER. Chlormethiazole and trifluoperazine in alcohol withdrawal. Br J Psychiatry 1969; 115: 1191–2

    PubMed  CAS  Google Scholar 

  154. Harfst MJ, Greene JG, Lassae FG. Controlled trial comparing amobarbital and chlormethiazole in alcohol withdrawal symptoms. Q J Stud Alcohol 1967; 28: 641–8

    PubMed  CAS  Google Scholar 

  155. Glatt MM, George HR, Frisch EP. Evaluation of chlormethiazole in treatment for alcohol withdrawal syndrome. Acta Psychiatr Scand 1966; 192 Suppl.: 121–37

    CAS  Google Scholar 

  156. Marcantonio ER, Goldman L, Mangione CM, et al. A clinical prediction rule for delirium after elective noncardiac surgery. JAMA 1994; 271(2): 134–9

    PubMed  CAS  Google Scholar 

  157. Inouye SK, Viscoli CM, Horwitz RI, et al. A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics. Ann InternMed 1993; 119(6): 474–81

    CAS  Google Scholar 

  158. Jacobson SA. Delirium in the elderly. Psychiatr Clin North Am 1997; 20(1): 91–110

    PubMed  CAS  Google Scholar 

  159. Hoey LL, Nahum A, Vance-Bryan K. A prospective evaluation of benzodiazepine guidelines in the management of patients hospitalized for alcohol withdrawal. Pharmacotherapy 1994; 14(5): 579–85

    PubMed  CAS  Google Scholar 

  160. Cavanaugh SV. Psychiatric emergencies. Med Clin North Am 1986; 70(5): 1185–202

    PubMed  CAS  Google Scholar 

  161. D’Onofrio G, Rathlev NK, Ulrich AS, et al. Lorazepam prevents recurrent alcohol-related seizures [abstract]. Acad Emerg Med 1995; 2: 368

    Google Scholar 

  162. Chance JF. Emergency department treatment of alcohol withdrawal seizures with phenytoin. Ann Emerg Med 1991; 20(5): 520–2

    PubMed  CAS  Google Scholar 

  163. Alldredge BK, Lowenstein DH. Status epilepticus related to alcohol abuse. Epilepsia 1993; 34(6): 1033–7

    PubMed  CAS  Google Scholar 

  164. Alldredge BK, Lowenstein DH, Simon RP. Placebo-controlled trial of intravenous diphenylhydantoin for short-term treatment of alcohol withdrawal seizures. Am J Med 1989; 87(6): 645–8

    PubMed  CAS  Google Scholar 

  165. Sampliner R, Iber FL. Diphenylhydantoin control of alcohol withdrawal seizures: results of a controlled study. JAMA 1974; 230(10): 1430–2

    PubMed  CAS  Google Scholar 

  166. Rathlev NK, D’Onofrio G, Fish SS, et al. The lack of efficacy of phenytoin in the prevention of recurrent alcohol-related seizures. Ann Emerg Med 1994; 23(3): 513–8

    PubMed  CAS  Google Scholar 

  167. Tavani CA. Perioperative psychiatric considerations in the elderly. Clin Geriatr Med 1990; 6(3): 543–56

    PubMed  CAS  Google Scholar 

  168. Gower WE, Kersten H. Prevention of alcohol withdrawal symptoms in surgical patients. Surg Gynecol Obstet 1980; 151(3): 382–4

    PubMed  CAS  Google Scholar 

  169. Craft PP, Foil MB, Cunningham PR, et al. Intravenous ethanol for alcohol detoxification in trauma patients. South Med J 1994; 87(1): 47–54

    PubMed  CAS  Google Scholar 

  170. Hansbrough JF, Zapata-Sirvent RL, Carroll WJ, et al. Administration of intravenous alcohol for prevention of withdrawal in alcoholic burn patients. Am J Surg 1984; 148(2): 266–9

    PubMed  CAS  Google Scholar 

  171. Carlen PL, McAndrews MP, Weiss RT, et al. Alcohol-related dementia in the institutionalized elderly. Alcohol Clin Exp Res 1994; 18(6): 1330–4

    PubMed  CAS  Google Scholar 

  172. Smith DM, Atkinson RM. Alcoholism and dementia. Int J Addict 1995; 30(13–14): 1843–69

    PubMed  CAS  Google Scholar 

  173. Whitcup SM, Miller F. Unrecognized drug dependence in psychiatrically hospitalized elderly patients. J Am Geriatr Soc 1987; 35(4): 297–301

    PubMed  CAS  Google Scholar 

  174. Kashner TM, Rodell DE, Ogden SR, et al. Outcomes and costs of two VA inpatient treatment programs for older alcoholic patients. Hosp Community Psychiatry 1992; 43(10): 985–9

    PubMed  CAS  Google Scholar 

  175. Kofoed LL, Toison RL, Atkinson RM, et al. Treatment compliance of older alcoholics: an elder-specific approach is superiorto ‘mainstreaming’. J Stud Alcohol 1987; 48(1): 47–51

    PubMed  CAS  Google Scholar 

  176. Bien TH, Miller WR. Brief interventions for alcohol problems: a review. Addiction 1993; 88: 315–36

    PubMed  CAS  Google Scholar 

  177. Samet JH, Rollnick S, Barnes H. Beyond CAGE: abrief clinical approach after detection of substance abuse. Arch Intern Med 1996; 156: 2287–93

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kraemer, K.L., Conigliaro, J. & Saitz, R. Managing Alcohol Withdrawal in the Elderly. Drugs & Aging 14, 409–425 (1999). https://doi.org/10.2165/00002512-199914060-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002512-199914060-00002

Keywords

Navigation