Dawaa Reference

Clinical reference

Acute alcohol withdrawal (referral & detoxification)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 sources

Egyptian National Drug Formulary - Nervous System Disorders 2025 · NICE Guideline CG100 · UK eMC Diazepam 5mg / 10mg Tablets SmPC (or DailyMed Diazepam Tablet Package Insert) · Vitamin B&C Intravenous High Potency (Pabrinex) SmPC sections 4.2 and 4.4 (eMC product 1427) · Folic Acid DailyMed label, SetID 0e7cb7ea-c94e-4ce6-8149-311dc9c94e03, DOSAGE AND ADMINISTRATION

Verified against3 documents
  • UK eMC Diazepam 5mg / 10mg Tablets SmPC (or DailyMed Diazepam Tablet Package Insert)
  • Vitamin B&C Intravenous High Potency (Pabrinex) SmPC sections 4.2 and 4.4 (eMC product 1427)
  • Alcohol Withdrawal Syndrome - disease-level clinical article (alcohol-withdrawal-referral-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

  • Shakiness, poor sleep, restlessness, and sweating typically begin hours after the last drink and peak around 72 hours [insomnia · irritability · sweating · tremor]
  • Hearing, seeing, or feeling things that are not there suggests alcoholic hallucinosis
  • Ask specifically about a past withdrawal that involved a seizure or delirium, since it predicts a rougher course this time [confusion · seizures]
  • It starts minor after the drinking stops - mild anxiety, headache, gut discomfort, insomnia [anxiety · headache · insomnia]
  • Alcoholic hallucinosis brings visual or auditory hallucinations that usually settle within 48 hours of the last drink [hallucinations]
  • Withdrawal seizures can happen within a few hours of stopping [seizures]

Signs — what you find (4)

  • Tremor, agitation, sweating, high blood pressure, fast heart rate, or seizures reflect loss of alcohol's calming effect on the brain [hypertension · irritability · seizures · sweating · tachycardia · tremor]
  • New confusion on top of the usual picture raises concern for withdrawal delirium [confusion]
  • Withdrawal delirium, formerly delirium tremens, brings fever, a fast pulse, agitation, heavy sweating, hallucinations, disorientation and high blood pressure [confusion · fever · hallucinations · hypertension · irritability · sweating]
  • Red flag: the window for withdrawal delirium is 3 to 8 days after the last drink, and although only 3% to 5% reach it, it can kill [confusion]

Tests (2)

  • The CIWA-Ar scale scores severity: 8 or below is mild, 8 to 15 is moderate, and above 15 is severe
  • CIWA-Ar only works in a patient who is awake and able to participate; the Minnesota Detoxification Scale is used otherwise

If not this — what else fits (5)

  • Withdrawal from a sedative-hypnotic such as a benzodiazepine or barbiturate can mimic this and should be ruled out
  • Consider a non-alcohol cause of seizure or delirium, such as another medical or neurologic problem
  • Thyrotoxicosis, low blood sugar, and diabetic ketoacidosis can produce a similar picture
  • A stroke or bleeding inside the skull needs to be excluded in a confused or seizing patient
  • Stimulant use and status epilepticus are also on the list of look-alikes

Scores

  • CAGE questionnaire — Is this drinking a problem?

SourceStatPearls "Alcohol Withdrawal Syndrome" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Vitamin replacement - folate

MAIN TREATMENT - choose one, plus any add-on marked below

1

DIAZEPAM

1st line

Strength10 mg

Formoral.solid

Adult dose and duration

Alcohol withdrawal: 5-20 mg, repeated if necessary in 2-4 hours.

Paediatric dose

Alcohol withdrawal in adolescents requires specialist inpatient pediatric addiction / toxicology management

Dose source

Diazepam 5 mg Tablets SmPC section 4.2 (eMC product 101912), Posology: "Alcohol withdrawal: 5-20 mg, repeated if necessary in 2-4 hours." eMC files each tablet strength as a separate product - 101912 for 5 mg, 101913 for 10 mg - and the 5 mg SmPC is the document quoted here.

Why

First-line long-acting benzodiazepine for alcohol withdrawal; oral lorazepam is not widely available in Egypt

Cautions
  • There is a high risk of respiratory depression if diazepam is combined with ongoing alcohol ingestion.
  • Monitor CIWA-Ar score to guide dosing.
  • Severe liver failure patients require short-acting benzodiazepines (e.g. oxazepam) to avoid accumulation.
Egyptian brands
Egyptian brandManufacturerIndicative price
EPIVAL 10 MG 20 TABS.EIPICO11.00 EGP (0.55/unit)
VALPAM 2MG/5ML SYRUP 120ML? strength differs? different route - not oral solidAMOUN5.95 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Alcohol Withdrawal Syndrome - disease-level clinical article (alcohol-withdrawal-referral-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • Admit rather than manage as an outpatient when there is a history of prior withdrawal seizures or of alcohol withdrawal delirium.
3

THIAMINE

add-on - not a substitute

Strength100 mg

Formoral.solid

Adult dose and duration

2 to 3 pairs of 5 ml ampoules diluted with 50 ml to 100 ml infusion solution administered over 30 minutes every 8 hours

Paediatric dose

Adolescent inpatient addiction treatment protocol

Dose source

Vitamin B&C Intravenous High Potency (Pabrinex) SmPC sections 4.2 and 4.4 (eMC product 1427)

Why

Standalone oral 100 mg thiamine tablets are not marketed in Egyptian commercial pharmacies; oral B-complex or parenteral thiamine is used.

Cautions
  • Standalone oral 100 mg thiamine tablets are unavailable in Egyptian commercial pharmacies.
  • Must administer thiamine PRIOR to intravenous glucose infusion to prevent acute precipitation of Wernicke encephalopathy.
  • Parenteral administration carries rare risk of anaphylaxis.
  • The parenteral form goes in as an infusion over 30 minutes, two to three pairs of ampoules every 8 hours - not a quick push. The rate is what keeps it safe.
  • Anaphylaxis is rare but real. Do not give it anywhere resuscitation facilities are not to hand. Sneezing or mild wheeze during a dose is the warning; the next dose is the one that kills.
  • Give the thiamine before any glucose. Glucose first in a depleted alcoholic precipitates the Wernicke's you are trying to prevent.
Egyptian brands

No Egyptian brand matched — prescribe by generic name.

VITAMIN REPLACEMENT - FOLATE - give alongside

4

FOLIC ACID

Vitamin replacement - folate

add-on - not a substitute

Formoral.solid

Adult dose and duration

1 mg once daily by mouth

Paediatric dose

Children of any age take the same dose, up to 1 mg daily.

Dose source

Folic Acid DailyMed label, SetID 0e7cb7ea-c94e-4ce6-8149-311dc9c94e03, DOSAGE AND ADMINISTRATION - verbatim: "The usual therapeutic dosage in adults and children (regardless of age) is up to 1 mg daily."

Why

The disease article asks for thiamine and folate together because these patients are usually nutritionally depleted; the card already gives thiamine, so folate completes the pair. It is cheap, widely stocked in Egypt and does not interact with the benzodiazepine cover.

Cautions
  • Do not go above 0.1 mg a day until vitamin B12 deficiency has been excluded or is already being treated, because folate alone can repair the blood picture while the neurological damage of B12 deficiency carries on.
  • This is replacement, not treatment of the withdrawal itself - it does not replace benzodiazepine cover or parenteral thiamine.
Egyptian brands
Egyptian brandManufacturerIndicative price
FOLIC 0.8MG 50 TAB.PHAROPHARMA13.50 EGP (0.27/unit)
FOLIC ACID (EL NILE) 5 MG 50 TAB.EL NILE.26.25 EGP (0.53/unit)
FOLIC ACID (MEMPHIS) 5 MG 30 TAB.MEMPHIS15.75 EGP (0.53/unit)
FOLICINAD 5 MG 50 TABS.INAD PHARMA50.00 EGP (1.00/unit)
FOLIRAQ 5000 MCG 30 CAPSULESHP PHARMA45.00 EGP (1.50/unit)
FOLIC ACID 800 MCG 250 TABLETS (PURITANS PRIDE)PURITANS PRIDE > ARAB IMPORTERS TRADING (AIT)525.00 EGP (2.10/unit)
SANSOFOLIC 800 MCG 28 TABS.AUG PHARMA110.00 EGP (3.93/unit)
FOLIRAQ 400 MCG TABSHP PHARMA42.00 EGP
FOLIDDOX 400 MCG / 5 ML LIQUID 150 ML? strength differs? different route - not oral solidMADDOX PHARMA150.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.