Delirium tremens medical therapy

Delirium Tremens Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]

Medical Therapy

• The mainstay of treatment for delirium tremens is supportive care and sedation.
• For sedation, benzodiazepines are the first choice.
• Long-acting benzodiazepines such as, diazepam and chlordiazepoxide are preferred over short-acting benzodiazepine to achieve a stable serum level.
• There are three options for the treatment of delirium tremens,
  • Front loading (Most preferred)
  • Symptom-triggered
  • Fixed-dose (Least preferred)

Contraindication: In case of liver impairment or lack of IV access, lorazepam is preferred over diazepam.

Pharmacotherapy is symptomatic and supportive. Typically the patient is kept sedated with benzodiazepines, such as diazepam (Valium), lorazepam (Ativan) or oxazepam (Serax) and in extreme cases low-levels of antipsychotics, such as haloperidol until symptoms subside. Older drugs such as paraldehyde and clomethiazole were the traditional treatment but these have now largely been superseded by the benzodiazepines, although they may still be used as an alternative in some circumstances. Acamprosate is often used to augment treatment, and is then carried on into long term use to reduce the risk of relapse. If status epilepticus is present, seizures are treated accordingly. Controlling environmental stimuli can also be helpful, such as a well-lit but relaxing environment to minimize visual misinterpretations such as the visual hallucinations mentioned above.