In acute alcohol withdrawal, which medication class is commonly used as first-line treatment?

• A. Benzodiazepines
• B. Beta blockers
• C. NSAIDs
• D. Antidepressants

Answer: (A)

In acute alcohol withdrawal, the aim is to calm the brain’s sudden overexcitability and prevent dangerous complications like seizures and delirium tremens. Benzodiazepines achieve this by enhancing GABA-A receptor activity, effectively substituting for alcohol’s depressant effect. This reduces agitation, tremor, anxiety, autonomic signs, and, crucially, seizure risk. Their rapid onset and the ability to titrate the dose make them the standard first-line treatment, often guided by a withdrawal severity scale so dosing is responsive and minimizes oversedation. Long-acting benzodiazepines such as diazepam or chlordiazepoxide are commonly used to provide a smooth withdrawal course, though in liver disease shorter-acting options like lorazepam or oxazepam may be preferred due to metabolism. Other medication classes may help with specific symptoms (beta blockers for tremor or tachycardia, NSAIDs for pain, antidepressants for mood symptoms) but they do not address the underlying CNS hyperexcitability or prevent withdrawal complications, so they aren’t first-line.