Dr. José R. Maldonado of Stanford University’s department of psychiatry and behavioral sciences believes that benzodiazepines are not the most effective or safest choice for patients undergoing alcohol withdrawal. Benzodiazepines have historically been used for alcoholics undergoing detox because they are tranquilizers that decrease the ability of nerves cells in the brain to get over-stimulated. This has been thought to be a potentially life-saving intervention for severe alcohol addiction because the withdrawal process can lead to a condition known as delirium tremens, commonly referred to as “the shakes,” which can be deadly if not managed with proper medical intervention. The tranquilizing ability of benzodiazepines can halt this process before seizures occur.
However, Dr. Maldonado does not believe that this is the best form of treatment for individuals in the detox phase of alcohol addiction. Instead, he feels that clonidine, an alpha-2 agonist, along with other supportive medications like valproic acid and gabapentin, have an effect equal to benzodiazepines without as great of a safety risk. Benzos put patients at risk for the following issues:
- Respiratory depression
- Increased risk of alcohol relapse post detox
Controlling Norepinephrine Is the Key to Overcoming Alcohol Withdrawal
Dr. Maldonado explains that targeting norepinephrine is key in managing alcohol withdrawal symptoms. He claims that roughly 85 percent of the withdrawal symptoms a patient experiences are due to an overabundance of norepinephrine in the system including:
- Cardiac problems
According to Dr. Maldonado, alpha-2 blockers, such as clonidine, slow down the release of the norepinephrine in the body. Dr. Maldonado claims that with his method of treatment he has never had a patient progress to the level of delirium tremens during alcohol withdrawal. A recent study in the journal Anesthesia & Analgesia found similar results with 13 percent of patients treated with benzos experiencing delirium tremens while none of the patients treated with clonidine ever showed any signs of tremors.
Clonidine May Replace Benzos as Gold Standard Treatment for Alcohol Detox
In Dr. Maldonado’s practice, he uses a simple formula for individuals attempting alcohol detoxification. He gives patients a 0.1 mg clonidine patch on each arm, then administers three doses of 0.1 mg clonidine orally at eight-hour intervals until the patches are able to reach their maximum effect. He uses gabapentin as a backup if necessary and claims, “We have had zero patients progress to alcohol withdrawal…Our protocol combines treatments so you have a double or triple safety net.”
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