{ "schema_version": 1, "kind": "condition", "id": "alcohol-withdrawal-referral", "name": "Acute alcohol withdrawal (referral & detoxification)", "category": "chronic", "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", "review_status": "reviewed", "verified_against": "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_date": "2026-08", "treatments": [ { "id": 122, "generic": "Diazepam", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 10.0, "adult_dose": "Alcohol withdrawal: 5-20 mg, repeated if necessary in 2-4 hours.", "adult_duration": null, "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.", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Alcohol withdrawal in adolescents requires specialist inpatient pediatric addiction / toxicology management", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "EPIVAL 10 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 11.0, "pack_count": 20, "unit_price": 0.55, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VALPAM 2MG/5ML SYRUP 120ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 5.95, "pack_count": null, "unit_price": null, "strength_mg": 2.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "alcohol-withdrawal-referral" }, { "id": 124, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Alcohol Withdrawal Syndrome - disease-level clinical article (alcohol-withdrawal-referral-clinical.txt)", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "alcohol-withdrawal-referral" }, { "id": 123, "generic": "Thiamine", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": 100.0, "adult_dose": "2 to 3 pairs of 5 ml ampoules diluted with 50 ml to 100 ml infusion solution administered over 30 minutes every 8 hours", "adult_duration": null, "dose_source": "Vitamin B&C Intravenous High Potency (Pabrinex) SmPC sections 4.2 and 4.4 (eMC product 1427)", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Adolescent inpatient addiction treatment protocol", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "alcohol-withdrawal-referral" }, { "id": 125, "generic": "Folic acid", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": null, "adult_dose": "1 mg once daily by mouth", "adult_duration": null, "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.\"", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children of any age take the same dose, up to 1 mg daily.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "FOLIC 0.8MG 50 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 13.5, "pack_count": 50, "unit_price": 0.27, "strength_mg": 0.8, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FOLIC ACID (EL NILE) 5 MG 50 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 26.25, "pack_count": 50, "unit_price": 0.53, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FOLIC ACID (MEMPHIS) 5 MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 15.75, "pack_count": 30, "unit_price": 0.53, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FOLICINAD 5 MG 50 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "INAD PHARMA", "price_egp": 50.0, "pack_count": 50, "unit_price": 1.0, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FOLIRAQ 5000 MCG 30 CAPSULES", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HP PHARMA", "price_egp": 45.0, "pack_count": 30, "unit_price": 1.5, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FOLIC ACID 800 MCG 250 TABLETS (PURITANS PRIDE)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PURITANS PRIDE > ARAB IMPORTERS TRADING (AIT)", "price_egp": 525.0, "pack_count": 250, "unit_price": 2.1, "strength_mg": 0.8, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SANSOFOLIC 800 MCG 28 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AUG PHARMA", "price_egp": 110.0, "pack_count": 28, "unit_price": 3.93, "strength_mg": 0.8, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FOLIRAQ 400 MCG TABS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HP PHARMA", "price_egp": 42.0, "pack_count": null, "unit_price": null, "strength_mg": 0.4, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FOLIDDOX 400 MCG / 5 ML LIQUID 150 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MADDOX PHARMA", "price_egp": 150.0, "pack_count": null, "unit_price": null, "strength_mg": 0.4, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "alcohol-withdrawal-referral" } ] }