đ #DrugQueryInbox: What are my thoughts on Ketamine as an adjunctive therapy for alcohol withdrawal? Is it ever my first go-to or do I prefer antipsychotics? (@lauralee_4)
đ Choosing between the two, I prefer antidopaminergics over Ketamine mostly since I'm going to be aggressive with Phenobarbital and shouldn't need Ketamine NMDA receptor antagonism.
đ The underlying problem with alcohol withdrawal is decreased GABA activity and excess glutamate, which is neuroexcitatory and a huge contributor to our hyperactive withdrawal symptoms.
đ„ Phenobarbital is the perfect TWO-FER for alcohol withdrawal since it increases GABA receptors activity via prolonging Cl- channel opening and reducing glutamate release by antagonizing the NMDA receptor. Antidopaminergics also have a longer half life and anti-emetic properties compared to Ketamine.
đ To avoid additional IV adjunctive therapies, I'd first offer oral agents such as chlordiazepoxide, gabapentin, or clonidine.
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