In the management of delirium tremens, which class of medications is commonly used?

• A. Opioid antagonists
• B. Antipsychotics
• C. Antidepressants
• D. Benzodiazepines

Answer: (D)

Delirium tremens is a life-threatening alcohol withdrawal state, so treatment aims to quickly calm CNS hyperexcitability and prevent seizures. Benzodiazepines boost GABA activity at the GABA-A receptor, which counteracts the hyperadrenergic, excitatory state caused by sudden alcohol cessation. This reduces tremors, agitation, autonomic instability, and the risk of seizures, making benzodiazepines the primary, most effective choice for management. They’re started and titrated to control symptoms (often with symptom-triggered or fixed-dose regimens) and tapered as stabilization occurs. While other classes can be used for specific concerns—opioid antagonists for opioid withdrawal, antipsychotics for agitation in delirium, antidepressants for mood disorders—they do not address the withdrawal physiology as effectively as benzodiazepines in this setting.