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Suggested Dosing for Alcohol Withdrawal Management

Suggested Dosing for Alcohol Withdrawal Management - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Nursing Practice Guidelines, Related



Last Updated Oct., 2014. Questions? Contact Addictive Disorders

Alcohol Withdrawal Management
Suggested Dosing Table for Standard and Reduced Dosing using the
CIWA‐Ar (Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised)
Target patient population: Adult inpatients/ED requiring lorazepam (ATIVAN) dosing to control symptoms of
alcohol withdrawal for 96 hours.
CIWA
SCORE

Monitoring STANDARD DOSING
Ongoing Dose
(96 Hours)
REDUCED DOSING
Ongoing Dose
(96 Hours)
<10 Document CIWA score and adult sedation score every 2 hours. If CIWA is <
10 x 4 consecutive measurements, CIWA
score and adult sedation score
every 4 hours x 48 hours, if still < 10, notify
provider to consider discontinuation.


None


None
10-15
(mild
withdrawal)
Document CIWA score Q 2 hours and adult
sedation score before lorazepam
administration.
Lorazepam (ATIVAN) 1 mg
IV/PO every hour PRN
CIWA score 10‐15.

Lorazepam (ATIVAN) 0.5
mg. IV/PO PRN every hour
PRN CIWA score 10‐15.
16-20
(Moderate
Withdrawal)
Document CIWA score, and adult sedation
score every 1 hour.
Lorazepam (ATIVAN) 2 mg
IV/PO every hour PRN
CIWA score 16‐20.

Lorazepam (ATIVAN) 1 mg
IV/PO every hour PRN score
16‐20.
>20
(Severe
Withdrawal)
Document CIWA score, and adult sedation
score every 1 hour.
***Notify provider if CIWA score is greater
than 20 for 2 consecutive measurements***.
Lorazepam (ATIVAN) 4 mg
IV/PO every hour PRN
CIWA score > 20. Notify
provider if CIWA score is
greater than 20 for 2
consecutive measurements***.
Lorazepam (ATIVAN) 2 mg
IV/PO every hour PRN
CIWA score > 20. Notify
provider if CIWA score is
greater than 20 for 2
consecutive measurements***
Additional Considerations for patients with moderate or severe withdrawal symptoms:
• Early, frequent reassessment and treatment with lorazepam is important to prevent escalation of symptoms.
• Haldol (haloperidol) may calm hallucinations/delirium, but does NOT treat alcohol withdrawal symptoms and may increase seizure risk. Be sure
patient has received adequate lorazepam prior to haloperidol use.
• Please access the CIWA Accordion Report in Patient Summary as a resource.