Which Medications Treat Alcohol Withdrawal Syndrome? How Benzos and Others Can Help

Over 76 million people around the world have alcohol use disorder. If you or someone you know is thinking about quitting alcohol, you may know how a day without a drink can make you feel anxious or shaky. And the truth is: Many people will have serious withdrawal symptoms when they stop drinking — or cut down. In some cases, withdrawal can even be life-threatening. 

Fortunately, medications can help make withdrawal safer and more manageable. Benzodiazepines (“benzos”) are one of the best medications for alcohol withdrawal symptoms. But there are other medications that can help too. 

Let’s take a closer look at the symptoms of alcohol withdrawal syndrome and the medications that can be used to treat it.

What are the symptoms of alcohol withdrawal syndrome?

Alcohol withdrawal syndrome is a cluster of symptoms that happen when a person stops drinking alcohol. It’s especially likely after periods of long-term or heavy drinking. 

Common symptoms of alcohol withdrawal syndrome include:

• Restlessness

• Trouble sleeping

• Nausea

• Vomiting

• Sweating

• Tremors

• Hallucinations

• Confusion

In some cases, people can also develop severe or life-threatening symptoms, such as:

• Seizures 

• Delirium tremens (shaking, sweating, and severe confusion)

• Elevated heart rate and blood pressure

• Death, in rare cases

It’s not always easy to predict who’ll have more severe withdrawal symptoms. If you regularly drink a heavy amount of alcohol, you may be more at risk. But the good news is there’s treatment to help with alcohol withdrawal syndrome. And these medications can be lifesaving for those who need them.

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Which medications treat alcohol withdrawal syndrome?

Benzos are the mainstay of medical treatment for alcohol withdrawal, so we’ll start there. Then we’ll dive into some other medications that can help.

Benzodiazepines

Benzodiazepines — especially long-acting benzos — are the first-choice medications for alcohol withdrawal syndrome. Benzos treat alcohol withdrawal symptoms by imitating the effects of alcohol in the brain. This allows them to essentially replace the effects of alcohol in the brain and prevent withdrawal symptoms. 

Long-acting benzos are preferred because they last longer in the body. They can be helpful for a smooth treatment course. And there’s less of a risk that the medication effect will wear off and that withdrawal symptoms will return. They also don’t need to be taken as often as shorter-acting versions. 

Commonly prescribed benzos for treating alcohol withdrawal syndrome are:

• Chlordiazepoxide (Librium)

• Diazepam (Valium)

• Lorazepam (Ativan)

• Oxazepam (Serax)

Sometimes, benzos can be prescribed for you to take at home. Other times, they’re given in a supervised treatment facility. It all depends on what setting is right for you. 

Your healthcare team will help figure out the right dose and schedule for your care. Each person and treatment regimen is a little different. Typically, people start with a high dose to get their symptoms under control. And then the dose is slowly lowered as the withdrawal symptoms improve. Regardless of the treatment regimen, alcohol withdrawal symptoms usually resolve in about a week, as long as you don’t drink more alcohol.

Benzos are generally safe and effective for treating alcohol withdrawal syndrome. But they can sometimes cause side effects, including:

• Fatigue (feeling tired)

• Memory problems

• Dizziness

• Trouble thinking

• Depression

• Confusion

Benzos also have a strong warning for the risk of misuse or dependence, which can lead to overdose and death. This risk goes up when people take high doses of benzodiazepines or combine them with other medications.

Since benzos can be habit forming, taking them can also lead to serious withdrawal reactions — just like alcohol. This is particularly true for people who take benzos for a long period of time. So you should always talk with your prescriber before completely stopping a benzo.

Barbiturates and propofol

Barbiturates (usually phenobarbital) and propofol are medications typically used for anesthesia. They also can help with seizures. These medications are sometimes used along with benzos when someone has a severe case of alcohol withdrawal syndrome, especially if their symptoms haven’t been fully controlled with benzos alone. 

Carbamazepine and gabapentin

Carbamazepine and gabapentin are anti-seizure medications, typically used together with benzos for alcohol withdrawal syndrome. They can also be used on their own for mild cases of alcohol withdrawal, or if benzos aren’t an option. Gabapentin is also sometimes used after the withdrawal period is over, to help with ongoing treatment. 

Clonidine and atenolol

Clonidine and atenolol are blood pressure medications. They can be used together with benzos to help control blood pressure, heart rate, and anxiety during withdrawal. They’re not typically used on their own for alcohol withdrawal syndrome, as they don’t prevent or treat more serious symptoms like seizures and delirium. 

Supportive treatments

Supportive care is very important in the treatment of alcohol withdrawal syndrome. This refers to other treatments that help keep the body running while it’s recovering from the syndrome. This may include:

• IV (intravenous) fluids to help with dehydration

• Fluids that contain glucose (sugar) for people who are malnourished

• Electrolyte replacements (like potassium and magnesium) 

• Vitamin supplementation (thiamine and folate) 

Can I take medications for alcohol withdrawal syndrome at home? 

Possibly. In some cases, alcohol withdrawal syndrome can be treated in an outpatient setting, meaning without the need for a hospital stay. It may depend on your risk for having more severe symptoms, like delirium tremens or seizures. 

If you’re interested in quitting or cutting down on alcohol, talk to your primary care provider about your risk for withdrawal. They can help you understand the pros and cons of outpatient care. And they can work with you on a treatment plan for withdrawal — including medications, if appropriate. 

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Written by:

Nicole Andonian, MD

Nicole Andonian, MD, is a private practice anesthesiologist in Orange County, California. Her focus is in general anesthesia, regional anesthesia, and acute pain management.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

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