How should I initiate pharmacological treatment for a patient diagnosed with delirium tremens in a primary care setting?

Initiation of pharmacological treatment for delirium tremens in primary care:

• Delirium tremens is a medical emergency and patients should be offered admission to hospital for medically assisted alcohol withdrawal whenever possible, as primary care settings lack the resources for safe 24-hour monitoring and management. This is the preferred and safest approach. ¹
• If hospital admission is not immediately possible and treatment must be initiated in primary care, oral lorazepam is recommended as the first-line pharmacological treatment for delirium tremens. ¹
• If symptoms persist or the patient declines oral medication, parenteral lorazepam or haloperidol may be considered, but these are off-label uses and require specialist oversight. ¹
• Patients with delirium tremens require close monitoring by healthcare professionals skilled in alcohol withdrawal management, which is generally not feasible in primary care. ¹
• Concurrent administration of thiamine should be given to prevent or treat Wernicke's encephalopathy, especially in malnourished or high-risk patients. ¹
• Given the complexity and risks, primary care clinicians should urgently refer or arrange transfer to secondary care for comprehensive management. ¹