Anticonvulsants

Carbamazepine (600 to 1200 mg per day) effectively minimises alcohol withdrawal symptoms and prevents alcohol withdrawal seizures, but does not effectively prevent recurrent (further) seizures in a withdrawal episode. 

Phenytoin and valproate do not effectively prevent the onset of alcohol withdrawal seizures and are not recommended. The role of other anticonvulsants (such as gabapentin, topiramate) is yet to be demonstrated in controlled studies compared to benzodiazepines, and are not currently recommended. 

There appears to be no advantage in adding anticonvulsants to benzodiazepines for preventing alcohol withdrawal seizures. 

Patients already prescribed and regularly taking anticonvulsants should continue this medication during withdrawal. Many people with heavy alcohol use have poor adherence to anticonvulsants while drinking, and may be at risk of seizures due to recent cessation of anticonvulsants. Measurement of anticonvulsant plasma levels should be considered before administering anticonvulsants. 

See ‘Treatment of severe withdrawal complications’ for discussion of patient management following alcohol withdrawal seizure, including the role of anticonvulsants in preventing further seizures following withdrawal.