Phenobarbital an effective treatment option for alcohol withdrawal

A new study published in The American Journal of Emergency Medicine has reported that during benzodiazepine shortages, phenobarbital is a safe and effective treatment alternative for alcohol withdrawal.

Alcohol withdrawal treatment varies widely. Benzodiazepines are the standard of care, with rapid onset and long durations of action.The study revealed that incorporating phenobarbital into a benzodiazepine-based protocol or as sole agent led to similar rates of ICU admission, length of stay, and need for mechanical ventilation in patients treated for alcohol withdrawal in the emergency department.

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Phenobarbital has similar pharmacokinetics to select benzodiazepines frequently used for alcohol withdrawal.

Amelia Nelson and associates conducted a systematic review to describe the effectiveness and safety during three time periods utilizing benzodiazepines and barbiturates for the acute treatment of alcohol withdrawal in the emergency department.

The study included a total of 300 adult patients who received at least one dose of treatment presenting to the ED for acute alcohol withdrawal from April 1st, 2016 to January 31st, 2018. Treatments were based on the availability of medication and given protocol at the time of presentation. The primary outcome was the rate of ICU admission.

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The investigators found that the overall baseline characteristics were equal across groups, except for age. There was no difference in the rate of ICU admission from the ED between groups and the rate of mechanical ventilation was no different across all the groups.

Benzodiazepines are the standard of care, with rapid onset and long duration of action. Treatment for alcohol withdrawal varies widely. Recent drug shortages involving IV benzodiazepines have required incorporation of alternative agents into treatment protocols.

Alcohol withdrawal results in increased physical and mental problems after one stops drinking alcohol or seriously cuts down the daily alcohol intake if the person is an alcoholic.

For full information log on to https://doi.org/10.1016/j.ajem.2019.01.002