What is the role of clonidine and beta-blockers in the treatment of delirium tremens (DTs)?

Updated: Nov 06, 2020
  • Author: Michael James Burns, MD, FACEP, FACP, FIDSA; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

Clonidine and beta-blockers have been used to treat the hyperadrenergic state of alcohol withdrawal. Although these agents may correct some of the autonomic manifestations of withdrawal, they have not been demonstrated to have any effect on seizures or DTs, and they should be used only in conjunction with benzodiazepines in the treatment of patients with alcohol withdrawal. The recommended dose for clonidine is 0.2 mg orally bid, but this dose should be individualized. Beta-blockers may obscure the vital sign abnormalities that occur early in alcohol withdrawal and prevent early recognition of more severe alcohol withdrawal. They should not be used alone, but only when combined with adequate sedative-hypnotic drug therapy. Beta-blockers that have been recommended include atenolol, metoprolol, propranolol, and labetalol. The usual contraindications for clonidine and beta-blockers apply.


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