WG is a 41-year-old female brought herself into the ER last night asking to “detox from vodka.” She tells you she has a long-standing history of alcohol dependence with multiple relapses. She also reports that she has experienced alcohol withdrawal seizures before. Current CIWA-Ar is 17. She denies any past medical history but lab work indicates hepatic insufficiency (LFTs x3 ULN). All other lab work is normal. She denies taking any medications. How will you manage this patients withdrawal syndrome? WG has made it through withdrawal without complications thanks to an appropriate management regimen. She would like to consider pharmacological treatment to maintain abstinence. Her LFTs have normalized now that she has been alcohol-free for the past week. She reports taking disulfiram during previous rehabilitation attempts but was unsuccessful, most likely because of adherence issues. Her medical chart indicates she has great insurance so prescription copayments shouldn’t be a problem. What abstinence medication would be most appropriate for WG?
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