Fixed-Schedule Therapy

Benzodiazepines given at fixed dosing intervals are a common therapy for alcohol withdrawal management, and are well suited to ambulatory withdrawal, community residential and inpatient withdrawal settings. Fixed schedules are also appropriate for complex hospitalised patients, ideally with daily review by specialist drug and alcohol clinicians. Fixed schedule regimens typically involve reducing doses over a 3 to 6 day period, and require regular clinical review (minimum of daily) to ensure the patient is not over or under-medicated (Table 8.5 provides an example of a fixed-schedule regimen). Fixed schedule regimens may be supplemented with additional diazepam as needed for people with low tolerance of withdrawal discomfort (for example, 5 mg 6 hourly as needed, based on clinical observation or alcohol withdrawal scale scores). 

Access to diazepam doses should be restricted (for example, daily dispensing) and/or doses supervised by carers for patients undertaking ambulatory withdrawal in order to prevent misuse of medication. Diazepam should not be used if the patient continues to drink alcohol and regular breathalyser readings should be used if in doubt.  

Note: * In practice, a hybrid approach can be recommended with fixed schedule plus an additional diazepam dose (for example, 5 mg 6 to 12 hourly as needed, based on clinical observation or alcohol withdrawal scale scores).

Note: CIWA-Ar – Clinical Institute Withdrawal Assessment for Alcohol Scale; AWS – Alcohol Withdrawal Symptoms – Rating Scale; QID – four times a day