A 44-year-old man with alcohol withdrawal presents with agitation and tachycardia. Which medication is commonly used as first-line therapy for delirium tremens?

A 44-year-old man with alcohol withdrawal presents with agitation and tachycardia. Which medication is commonly used as first-line therapy for delirium tremens?

• A. Diazepam
• B. Lorazepam
• C. Chlordiazepoxide
• D. Alprazolam

Answer: (C)

Delirium tremens is best managed by using a benzodiazepine to suppress the CNS hyperactivity that comes with alcohol withdrawal. The goal is to provide steady GABAergic activity over the entire withdrawal period and to prevent seizures, agitation, and further delirium. A long-acting benzodiazepine fits this need because its effects last longer, reducing the chance of symptoms returning between doses and allowing a smoother taper as the patient recovers. Chlordiazepoxide has a long half-life and active metabolites, so it covers the withdrawal period effectively and is commonly used as first-line therapy in standard withdrawal protocols. Shorter-acting options would require more frequent dosing and carry a higher risk of rebound symptoms, while another long-acting option could be used in some settings, but the classic first-line choice in many guidelines remains the long-acting benzodiazepine with gradual tapering.

Delirium tremens is best managed by using a benzodiazepine to suppress the CNS hyperactivity that comes with alcohol withdrawal. The goal is to provide steady GABAergic activity over the entire withdrawal period and to prevent seizures, agitation, and further delirium. A long-acting benzodiazepine fits this need because its effects last longer, reducing the chance of symptoms returning between doses and allowing a smoother taper as the patient recovers. Chlordiazepoxide has a long half-life and active metabolites, so it covers the withdrawal period effectively and is commonly used as first-line therapy in standard withdrawal protocols.

Shorter-acting options would require more frequent dosing and carry a higher risk of rebound symptoms, while another long-acting option could be used in some settings, but the classic first-line choice in many guidelines remains the long-acting benzodiazepine with gradual tapering.