Journal List > J Korean Neuropsychiatr Assoc > v.52(2) > 1017665

Kim, Lee, Lee, Joe, Choi, and Seo: Korean Addiction Treatment Guidelines Series (II): Pharmacological Treatment of Alcohol Withdrawal

Abstract

Objectives

In development of Korean addiction treatment guidelines, the aim of this study was to investigate the experts' consensus regarding current pharmacological practice in treatment of alcohol withdrawal.

Methods

Using recommendations from foreign clinical guidelines, which were either lacking in evidence or could not be directly applied to Korea, the executive committee developed a questionnaire consisting of 17 questions. Using a nine-point scale, members of the Korean Addiction Psychiatry, who were experts (n=150) with sufficient experience in treatment of alcohol use disorder, were asked to evaluate the appropriateness of each item on the questionnaire. We classified the experts' opinion according to three categories, based on the lowest scores of 6.5 or greater as a first-line/preferred treatment, 3.5-6.5 as a second-line/reasonable treatment, and lower than 3.5 as a third-line/inappropriate treatment. The consensus was determined by chi-square test (p<0.05). Response rate was 70.4% (81/115).

Results

The results of the survey from the experts were as follows: 1) Symptom triggered therapy (STT) was the most appropriate strategy in treatment of alcohol withdrawal (95% CI 7.41-8.04). 2) Prophylactic benzodiazepine was recommended for management of expecting alcohol withdrawal in out-patient-department patients. 3) Among benzodiazepines, lorazepam was the most preferred. 4) For patients with severe withdrawal, lorazepam 7.4 mg/day (95% CI 6.48-8.25, maximum dose=20 mg) was recommended. 5) Risperidone, quetiapine, and haloperidol were the first-line drugs for patients with alcohol withdrawal and combined psychotic symptoms. 6) 127.5 mg (95% CI 111-145) for 2.8 months of prophylactic thiamine and 213.5 mg (95% CI 190-240) for 6.2 months of thiamine for Wernicke-Korsakoff's syndrome were recommended.

Conclusion

We hope that these Korean addiction treatment guidelines, added by the Korean experts' consensus, will be helpful in promoting the efficacy of treatment for alcohol withdrawal.

Figures and Tables

Fig. 1
RAND Corporation's 9-point scale for rating appropriateness of medical decisions.
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Table 1
The type of affiliations and response rate
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Table 2
Three strategies using benzodiazepine for alcohol withdrawal
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STT : Symptom triggered therapy, LDT : Loading dose therapy, FST : Fixed-schedule therapy, SD : Standard deviation, 95% CI : 95% confidence interval

Table 3
Preference of benzodiazepine in alcohol withdrawal
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*: No consensus. SD : Standard deviation, 95% CI : 95% confidence interval

Table 4
Daily dosage of benzodiazepine according to severity of alcohol withdrawal symptoms
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CIWA-Ar : Clinical Institute Withdrawal Assessment for Alcohol, Min : Minimum doses, Max : Maximum dose, SD : Standard deviation

Table 5
Preference of antipsychotics for alcohol withdrawal with psychotic symptoms
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SD : Standard deviation, 95% CI : 95% confidence interval

Table 6
Dosage and duration of thiamine for Wernicke-Korsakoff's syndrome prevention and treatment
jkna-52-67-i006

Min : Minimum dose, Max : Maximum dose, SD : Standard deviation, 95% CI : 95% confidence interval

Notes

The authors have no financial conflicts of interest.

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