Does phenobarbital add benefit in treating alcohol withdrawal syndrome?
March 29, 2013, 7:43 pm
Phenobarbital for Acute Alcohol Withdrawal: A Prospective Randomized Double-Blind Placebo-Controlled Study. Rosenson J et al. J Emerg Med 2013;44:592-598.
This well done study looked primarily at the effect of adding phenobarbital to standardized symptom-triggered therapy (using lorazepam). The primary outcome was the rate of ICU admission.
One hundred and two patients were randomized to receive either the standard treatment (N=51) or standard treatment plus an initial dose of IV phenobarbital (10mg/kg). Although baseline characteristics were similar between the two groups, the placebo group had a 10% higher incidence of altered mental status.
The results showed that the group that received phenobarbital had significantly fewer ICU admissions (8% v 25%). There were no significant differences in the need for intubation (1 patient in each group) or incidence of other adverse outcomes.
Of course, this study took place at one institution (Highland Hospital in Oakland) that was following a very specific treatment protocol for alcohol withdrawal syndrome. It is not clear whether it would be at all generalizable to other settings. The authors note that phenobarbital might add benefit because it has a longer duration of action than does lorazepam. It is possible that using a longer-acting benzodiazepine such as diazepam might give the same advantage without complicating the treatment regimen.