In alcohol withdrawal, which medication is used initially to prevent complications?

• A. Naloxone.
• B. Benzodiazepines (e.g., lorazepam) with supportive care and monitoring.
• C. Disulfiram.
• D. Thiamine alone.

Answer: (B)

Blunting CNS hyperexcitability is the priority in alcohol withdrawal to prevent complications like seizures and delirium tremens. The best approach is a benzodiazepine given with supportive care and close monitoring. Benzodiazepines enhance GABA-A receptor activity, which calms autonomic overactivity, reduces agitation, tremors, and the risk of seizures, and can be titrated based on symptoms. Lorazepam is often preferred when liver function is a concern because its metabolism is safer and more predictable in hepatic disease. Alongside the benzo, provide IV fluids, correct electrolytes, monitor vitals, and give thiamine to prevent Wernicke’s encephalopathy (ideally before glucose). The other options don’t address the acute withdrawal physiology: naloxone treats opioid overdose, disulfiram is for relapse prevention rather than acute withdrawal, and thiamine alone prevents a vitamin deficiency–related complication but does not control withdrawal symptoms or prevent seizures.