Diazepam (Valium)isusuallythefirst drugofchoicein treating withdrawal symptoms becauseof therapidonsetofaction and prolonged durationofeffect. The drugdepressesalllevelsof the CNS andprobably increasesGABA activity. The dosage shouldbeindividualizedandcarefully monitored asitcan lead to progressive apnea andhypotension.Theusual dosageis5-10mg IVevery 2-15minutes. The dosage may be increased up to 20 mg IV andgiven frequentlyup toseveral hoursoruntil the personislightly sedated. Large dosesmayneedto begiven,toachievethedesired results.Usewith cautioninpatientswith hepatic disease, low albumin levels, or with other CNSdepressants.Oxazepam (Serax) is usually used to treat Level I alcoholwithdrawal. The 15-30 mg doseisgiven orally. Most oftenit is seenin anoutpatient setting. Contraindication includesnarrow angle glaucoma, historyofsubstance abuse,andsevere uncontrolled pain.Lorazepam (Ativan) takes about20minutestoachievethe peek effect.Oneside effectis theloweringofbloodpressure.Theblood pressure shouldbemonitored veryfrequently.Theusual doseis 1-2 mg IVbolus every2-5 minutes untilthedesired effectisachieved (patientis sedated).Beespecially diligentforoversedationorrespiratory depression occurring about 20-30 minutes afterthe last doseasthe drug peaks slowly. Thisisthe drugofchoiceifthe personhasprofound liver involvement.It isa very effective drugforwithdrawal symptoms whentheperson is able to take oral medications.Midazolam (Versed)has avery brief half-life. Personsreceiving this needaconstant infusiontomaintainsedation.Thedrugisexpensiveand nomore effectivethat other benzodiazepines.Thedrugisused whenother cross-tolerant drugsare notavailableorwhenanintravenous accessisreadily available. The usual doseis 2mg bolus dose followedby atitrated intravenous solution.Itiscontraindicated with narrow angle glaucomaandhypotension.Barbiturates (drugs of choice if person does not respondto benzodiazepines)Phénobarbital (Luminal) effectively reducesthesymptomsofwithdrawal.It use islimiteddue tohypotensionandrespiratory depression. PersonsonThe Alabama Nurse•Page15this drugmayneed mechanical ventilation.Theusualdoseis 3-5mg/kgofbody weightIV orIM.Itmayberepeated every 30-45 minutes untilthepersonissedated,hypotension occursor15mg/kg have been administered.Contraindications are hypotension and known sensitivity.Pentobarbital (Nembutal)is ashort acting drug thatmaybegiven IVatthe rateoflOOmg IV over 1-2 minutesevery 5-15 minutes untilthepersonissedated. The maincontraindication is liver failure.Cardiovascular Agents (these drugs are used inconjunction with other medications and never used asmonotherapy)Clonidine (Catapres) decreases blood pressure and pulserate (less predictable). Very useful in opiate withdrawal asitdiminishes excessive lacrimation, diarrhea, and tachycardia.