Is delirium tremens occur during acute alcohol intoxication ?

Delirium tremens is a severe withdrawal reaction to alcohol. Alcohol intoxication is a state that occurs following intake of alcohol. It usually occurs in individuals who is getting rapid increase in blood alcohol concentration.

This was a question asked from me.

Both Delirium tremens and Alcohol intoxication can become life threatening. Alcohol intoxication is life threatening due to large quantities of alcohol in the blood which depresses brain activity. Sometimes such depression of brain activity can result in inhibition of respiratory center. Usually normal people get vomiting before alcohol reach such dangerous levels.

Usually vomiting occurs before alcohol reach dangerous blood level

What happens in delirium tremens

But delirium tremens kills in a very different way. Delirium tremens occur in a person who is alcohol dependent and then stops taking alcohol suddenly. In an alcohol dependent person brain neurochemistry alters so he can tolerate alcohol. Once alcohol is withdrawn from the body, unopposed neurochemical changes become hyperactive and can become life threatening.

Symptoms of delirium tremens is characterized by gross tremors, seeing things that are not real and sudden changes in body temperature and sudden changes in blood pressure. These things can sometimes become so severe, it can kill the person.

It is claimed that people with delirium tremens see small pink elephants!!

It usually does not occur during an usual episode of acute alcohol withdrawal. It occurs only in a dependent alcoholic.

So when an Alcohol dependent person stops taking alcohol, he/she should consult a doctor before doing so. It is very important.

See this article to see medications and how doctors treat delirium tremens.  

Use of Anxizide for alcohol withdrawal and its side effects

Anxizide is a brand of Chlodiazepoxide manufactured in India.
It is a long acting drug of the benzodiazepine family. It is a prescription only medication used in anxiety disorders and alcohol withdrawal. Main side effects are lightheadedness and drowsiness.

How Anxizide acts?

It increases the action of GABA type A receptors. This increases the inhibitory neurotransmission in the brain and it relieves anxiety and induces side effects such as drowsiness.

It works in alcohol withdrawal as it will counter balances the effects caused by alcohol withdrawal. In alcohol dependence there are certain changes happening in the brain which will become unopposed when the alcohol is suddenly discontinued. Alcohol withdrawal can become very dangerous (lethal) if not treated adequately.

Anxizide is also called Librium

Use in Alcohol withdrawal

 Anxizide mainly used as a detoxification agent in the acute alcohol withdrawal. Usually doctors start from very high doses in alcohol withdrawal and gradually tailing it off over period of time (Usually within five to six days). Also it is prescribed in the management of anxiety disorders and for short term relief of anxiety.

Alcohol withdrawal is the main indication of Anxizide

Usual starting dose would be 30mg thrice daily for one day. Then it is gradually tailed off depending on the response.

What the doctor should know before prescribing?

If you have any medical problems such as kidney disease, liver disease, breathing disorders or myasthenia gravis, discuss with your doctor before taking Anxizide. If you are pregnant, your doctor may not prescribe this medication, especially in last three months of the pregnancy.

General advice to avoid/minimize side effects

This medication is available as capsules. It should be taken as whole with a full glass of water. This medication must be taken according to the advice given by the doctor. You should avoid alcoholic beverages during the drug therapy. Operating machinery and driving is not recommended while on this medication. If the drowsiness is severely affecting patient’s day to day activities, it is recommended to discuss about the dosing schedule with the doctor.

Side effects of Anxizide

Most common side effects are light headedness and drowsiness which can continue to the next day. If the patient is taking Chlordiazepoxide for alcohol withdrawal, chances are high that he is taking high doses of the drug. This makes the side effects severe in patients who are taking the drug for alcohol withdrawal. Rarely excitation and aggression can occur (paradoxical excitation).

Confusion and ataxia (loss of full control of bodily movements) is also common. This usually manifest as a tremor when patient tries to move. Confusion and ataxia is common in elderly patients. It can also cause recent memory loss. Muscle weakness is also common.

If the patient continues to take the drug for a longer period, then patient can become dependant on the drug. That means having withdrawal symptoms after stopping the drug.

Occasionally patients complain of a headache. This can be controlled by taking over the counter pain killers such as paracetamol. Vertigo is another symptom that can occur occasionally.

Sometimes faintishness can occur due to low blood pressure (Hypotension) due to Anxizide. Some patients will have gastro intestinal disturbances like nausea, vomiting and diarrhea.

Some patients will have visual hallucinations, illusions and various other visual disturbances but they are very uncommon. Rarely patients can develop urinary incontinence and urinary retention. Also there are harmful interactions with other central nervous system depressants like opiates.


Summary
Anxizide is a medication in Benzodiazepine drug class. It is used primarily in alcohol detoxification. Main side effects are nausea, drowsiness and light headedness.

Sources
British National Formulary