In alcohol withdrawal, what is the recommended first-line treatment for moderate to severe withdrawal?

In alcohol withdrawal, what is the recommended first-line treatment for moderate to severe withdrawal?

• A. Haloperidol
• B. Disulfiram
• C. Naltrexone
• D. IV benzodiazepines

Answer: (D)

In moderate to severe alcohol withdrawal, the goal is to rapidly quell CNS hyperexcitability by boosting GABAergic inhibition. A benzodiazepine does this effectively by enhancing GABA-A receptor activity, which helps control tremors, autonomic instability, agitation, and, importantly, prevents seizures and progression to delirium tremens. Giving it intravenously allows quick, titratable control to bring symptoms under supervision in a hospital setting. A symptom-guided approach—often using a CIWA-Ar framework—lets dosing be adjusted to the patient’s ongoing needs until stabilization is achieved. Among benzodiazepines, IV forms such as diazepam or lorazepam are commonly used, with lorazepam sometimes preferred in liver disease due to its metabolic pathway. Other options listed do not address the acute withdrawal biology as effectively: one is mainly for agitation without preventing seizures, and the others are relapse-prevention medications, not acute withdrawal management.

In moderate to severe alcohol withdrawal, the goal is to rapidly quell CNS hyperexcitability by boosting GABAergic inhibition. A benzodiazepine does this effectively by enhancing GABA-A receptor activity, which helps control tremors, autonomic instability, agitation, and, importantly, prevents seizures and progression to delirium tremens. Giving it intravenously allows quick, titratable control to bring symptoms under supervision in a hospital setting. A symptom-guided approach—often using a CIWA-Ar framework—lets dosing be adjusted to the patient’s ongoing needs until stabilization is achieved. Among benzodiazepines, IV forms such as diazepam or lorazepam are commonly used, with lorazepam sometimes preferred in liver disease due to its metabolic pathway. Other options listed do not address the acute withdrawal biology as effectively: one is mainly for agitation without preventing seizures, and the others are relapse-prevention medications, not acute withdrawal management.