Gross tremors and seizures from acute alcohol withdrawal are treated with which class of medication?

• A. Benzodiazepines such as lorazepam and diazepam
• B. Beta blockers
• C. Antipsychotics
• D. Opioids

Answer: (A)

Benzodiazepines are the go-to treatment for acute alcohol withdrawal tremors and seizures. They work by enhancing the effect of GABA, the brain’s main inhibitory neurotransmitter, at the GABA-A receptor. In alcohol withdrawal, the brain becomes hyperexcitable after the depressant effect of alcohol is removed; boosting GABA activity helps quiet that excessive neuronal firing, reducing tremors, anxiety, and autonomic arousal, and most importantly preventing withdrawal seizures. Their anticonvulsant and sedative properties make them especially effective and safer for managing withdrawal symptoms, and dosing can be adjusted and tapered to avoid further withdrawal from the medication itself.

Other options don’t address the underlying hyperexcitability: beta blockers can lessen tremor and tachycardia but don’t prevent seizures; antipsychotics may help agitation but can lower seizure threshold and aren’t first-line for withdrawal; opioids are not appropriate and can worsen CNS depression.