# Acute alcohol withdrawal (referral & detoxification) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## 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) ## Treatment metadata - Diazepam — 10 mg — oral.solid - Referral & safety-netting (no drug therapy) - Thiamine — 100 mg — oral.solid - Folic acid — oral.solid ## Complete treatment card ```text ACUTE ALCOHOL WITHDRAWAL (REFERRAL & DETOXIFICATION) 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 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) (2026-08) 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 Score CAGE questionnaire - Is this drinking a problem? Source StatPearls "Alcohol Withdrawal Syndrome" - disease-level clinical article Status 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] Adult Alcohol withdrawal: 5-20 mg, repeated if necessary in 2-4 hours. Peds Alcohol withdrawal in adolescents requires specialist inpatient pediatric addiction / toxicology management 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 Caution 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. Egypt EPIVAL 10 MG 20 TABS. EIPICO 11.00 EGP (0.55/unit) VALPAM 2MG/5ML SYRUP 120ML AMOUN 5.95 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. Caution 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] Adult 2 to 3 pairs of 5 ml ampoules diluted with 50 ml to 100 ml infusion solution administered over 30 minutes every 8 hours Peds Adolescent inpatient addiction treatment protocol 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. Caution 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. Egypt no Egyptian brand matched - prescribe by generic name VITAMIN REPLACEMENT - FOLATE - give alongside 4. FOLIC ACID [add-on - not a substitute] Adult 1 mg once daily by mouth Peds Children of any age take the same dose, up to 1 mg daily. 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. Caution 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. Egypt FOLIC 0.8MG 50 TAB. PHAROPHARMA 13.50 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. MEMPHIS 15.75 EGP (0.53/unit) FOLICINAD 5 MG 50 TABS. INAD PHARMA 50.00 EGP (1.00/unit) FOLIRAQ 5000 MCG 30 CAPSULES HP PHARMA 45.00 EGP (1.50/unit) FOLIC ACID 800 MCG 250 TABLETS (PURITANS PRIDE) PURITANS PRI... 525.00 EGP (2.10/unit) SANSOFOLIC 800 MCG 28 TABS. AUG PHARMA 110.00 EGP (3.93/unit) FOLIRAQ 400 MCG TABS HP PHARMA 42.00 EGP FOLIDDOX 400 MCG / 5 ML LIQUID 150 ML MADDOX PHARMA 150.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)