Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct;56(5):550-559.
doi: 10.1177/0018578720931464. Epub 2020 Jun 2.

Evaluation of a Phenobarbital-Based Protocol for Severe Alcohol Withdrawal in Critically Ill Patients

Melanie Goodberlet  1 , Kevin Dube  1 , Mary Kovacevic  1 , Paul Szumita  1 , Jeremy DeGrado  1
Affiliations

Evaluation of a Phenobarbital-Based Protocol for Severe Alcohol Withdrawal in Critically Ill Patients

Melanie Goodberlet et al. Hosp Pharm. 2021 Oct.

Abstract

Background: Phenobarbital offers several possible advantages to benzodiazepines including a longer half-life and anti-glutamate activity, and is an alternative for the treatment of alcohol withdrawal. The objective of this analysis was to evaluate the safety and efficacy of a phenobarbital protocol for alcohol withdrawal newly implemented at our institution. Methods: This was a single-center, retrospective analysis of adult patients admitted to the medical/surgical/burn/trauma intensive care unit (ICU) with or at risk of severe alcohol withdrawal. Patients who were admitted prior to guideline implementation and received scheduled benzodiazepines (PRE) were compared to those who received phenobarbital post guideline update (POST). The primary outcome was ICU length of stay (LOS). Results: Upon analysis, 68 patients in the PRE and 64 patients in the POST were identified for inclusion. The median APACHE II score was significantly higher in the POST (4.5 [3:9] vs 10 [5:13], P < 0.001). ICU (2 [1:2] vs 2 [2:5], P = 0.002) and hospital (4.5 [3:6] vs 8 [6:12], P < 0.001) LOS were significantly longer in the POST. There was no difference in mortality or duration of mechanical ventilation. More patients required propofol or dexmedetomidine on day one in the POST (P < 0.001). Conclusion: Patients in the POST had significantly longer ICU and hospital LOS, and had a higher baseline severity of illness. Future research is needed to evaluate the efficacy and safety of phenobarbital compared to benzodiazepines for severe alcohol withdrawal.

Keywords: critical care; neurology; psychiatric.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Patient exclusion.
See this image and copyright information in PMC

References

    1. Maldonado JR, Sher Y, Ashouri JF, et al. The “Prediction of Alcohol Withdrawal Severity Scale” (PAWSS): systematic literature review and pilot study of a new scale for the prediction of complicated alcohol withdrawal syndrome. Alcohol. 2014;48(4):375-390. - PubMed
    1. Bayard M, Mcintyre J, Hill KR, Woodside J. Alcohol withdrawal syndrome. Am Fam Phys. 2004;69(6):1443-1450. - PubMed
    1. Saitz R, Horton NJ, Larson MJ, Winter M, Samet JH. Primary medical care and reductions in addiction severity: a prospective cohort study. Addiction. 2005;100(1):70-78. - PubMed
    1. Carta M, Olivera DS, Dettmer TS, Valenzuela CF. Ethanol withdrawal upregulates kainate receptors in cultured rat hippocampal neurons. Neurosci Lett. 2002;327(2):128-132. - PubMed
    1. Haugbol SR, Ebert B, Ulrichsen J. Upregulation of glutamate receptor subtypes during alcohol withdrawal in rats. Alcohol Alcohol. 2005;40(2):89-95. - PubMed

LinkOut - more resources