Detoxification protocols and withdrawal scales
7. CHLORDIAZEPOXIDE REGIMES
Baseline regime.
| SADQ Units/week (if SADQ unavailable) | Baseline regime | |
|---|---|---|
| <20 | <150 units | 20mg qds decreasing to zero over 7 days |
| 20 to 30 | 150-200 units per week | 30mg qds decreasing to zero over 7 days |
| 30 to 40 | 200-250 units per week | 40mg qds decreasing to zero over 8 days |
| 40 to 50 | 250-300 units per week | 50mg qds decreasing to zero over 9 days |
| 50 to 60 | >300 units per week | 60mg qds decreasing to zero over 10 days |
A baseline regime will be agreed before commencement of detoxific of detoxification with the consultant, according to the above criteria.This should be based on a SADQ score wherever possible, but if this is not available may be estimated from the reported number of units of alcohol used weekly.
Commencing detoxification.
If the alcometer reading is positive, then the first dose of chlordiazepoxide on the first day of detoxification should only be taken if the CIWA-Ar is > 15.
Altering the baseline regime during detoxification.
i) Over-medication.
If the patient appears over-sedated on a particular regime, or if the sedation scale reads 13 or below, then the next dose of chlordiazepoxide should be omitted.
If the CIWA-Ar remains below 9 for both readings on a single day, then the planned regular dosage for the following day should be replaced by that of the day after.This will have the effect of shortening the duration of detoxification by one day. For example, if the CIWA-Ar is 8 on both of Tuesday’s readings, then the schedule planned for Thursday should be administered on Wednesday, the schedule planned for Friday should be administered on Thursday etc.etc.
ii) Under-medication.
If the CIWA-Ar is > 15, then the next dose of chlordiazepoxide given should be 50% greater than the planned dose (up to a maximum of 60mg in a single dose).
If the CIWA-Ar is > 29, then the next dose of chlordiazepoxide should be 100% greater than the planned dose (up to a maximum of 60mg in a single dose).
If the CIWA-Ar is > 39, the consultant should be contacted to discuss the case, or if he is unavailable, the client should be taken to A&E for assessment.
If the CIWA-Ar remains >15 for both readings on a single day then the planned dosage for the following day should be replaced by that of the day on which the readings took place.This will have the effect of lengthening the duration of detoxification by one day. For example, if the CIWA-Ar is 16 on both of Tuesday’s readings, then the schedule for Tuesday should be administered on Wednesday, the schedule planned for Wednesday should be administered on Thursday etc.etc.
iii) Drinking during detoxification.
If the alcometer reads positive during detoxification, then the next dose of chlordiazepoxide should only be given if the CIWA-Ar is > 15.
If the client drinks on 2 concurrent days during detoxification, then the detoxification should cease. In such a case, the client should be advised to continue drinking at a level of approximately 75% of their regular consumption in the week immediately preceding detoxification, and then to cut down slowly over a period of several weeks.
** The CIWA-Ar should be completed as if the observation was occurring immediately before the most recently taken dose of chlordiazepoxide.
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The above information is copyright of Dr Bruce Trathen MBBS MRCPsych (2006). ISBN 0-9545164-0-0. The author grants permission for these guidelines to be downloaded, copied and distributed freely, but does not grant permission for their sale.
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