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Alcohol withdrawal — UKMLA MCQ

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ModeratePsychiatryAlcohol withdrawalUKMLAMRCP Part 1MRCEM SBAPARAPSA

A 54-year-old man with alcohol dependence is admitted to an acute medical unit 10 hours after his last alcoholic drink. He has tremor, sweating and anxiety, and his CIWA-Ar score indicates moderate withdrawal. He is orientated, has had no seizures or hallucinations, can take oral medication and has no evidence of decompensated liver disease. The unit has trained staff providing 24-hour assessment and monitoring. In addition to appropriate thiamine, which is the most appropriate initial regimen to control his withdrawal symptoms?

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Correct answer: A — Oral diazepam using a symptom-triggered regimen

Oral diazepam in a symptom-triggered regimen is appropriate. Benzodiazepines are standard pharmacological treatment for alcohol withdrawal; diazepam and chlordiazepoxide are commonly used in the UK. A symptom-triggered regimen is suitable in an inpatient setting where trained staff can repeatedly assess withdrawal severity and monitor treatment response. Haloperidol is not benzodiazepine-replacement monotherapy and is considered only in selected patients with delirium tremens or persistent severe agitation. Intravenous benzodiazepines are generally reserved for severe or complicated withdrawal, inability to take oral treatment, or closely monitored emergency settings. Withholding medication risks progression to seizures or delirium tremens in moderate withdrawal. Disulfiram is a relapse-prevention treatment considered after withdrawal has been completed, not treatment for acute withdrawal.

Reference: Department of Health and Social Care. Clinical guidelines for alcohol treatment, Chapter 10: Pharmacological interventions, sections 10.3.3–10.3.5. Updated 17 April 2026. https://www.gov.uk/guidance/clinical-guidelines-for-alcohol-treatment/10-pharmacological-interventions