What is the first-line treatment for delirium tremens?

• A. Benzodiazepines
• B. Antipsychotics
• C. Beta blockers
• D. Antidepressants

Answer: (A)

Delirium tremens is a life-threatening alcohol withdrawal state characterized by severe agitation, tremors, autonomic hyperactivity, and confusion. The first-line treatment is benzodiazepines because they enhance GABA neurotransmission, directly counteracting the CNS hyperexcitability that drives withdrawal. This sedative, anticonvulsant effect calms agitation, stabilizes heart rate and blood pressure, and prevents withdrawal seizures and progression to more severe delirium. Benzodiazepines can be given in a fixed schedule or symptom-triggered approach and can be adjusted for liver function, often with careful tapering as symptoms improve.

Antipsychotics may be used for agitation or hallucinations, but they do not address the underlying withdrawal physiology and carry risks such as respiratory depression or lowering the seizure threshold. Beta blockers treat some sympathetic symptoms like tachycardia but do not prevent delirium or withdrawal seizures. Antidepressants are not appropriate for acute management of delirium tremens.