A Comparison of Phenobarbital Dosing Strategies for the Treatment of Alcohol Withdrawal Syndrome
Pavan Sastry, Jessica Hasty, Jane Litwak, Victor Zach, Joseph F. Sucher, Jeffrey F. BarlettaBackground:
The preferred dosing strategy for phenobarbital in alcohol withdrawal syndrome (AWS) is not well established.
Objective:
We compared the effects of a 10- vs 20-mg/kg dose on the incidence of severe AWS and benzodiazepine use.
Methods:
This retrospective cohort study included patients who received a phenobarbital front-loaded dose with either 10 mg/kg or 20 mg/kg. The primary endpoints were severe AWS (Clinical Institute Withdrawal Assessment [CIWA] score ≥15, use of restraints, or seizures) and total lorazepam equivalents. Secondary endpoints were the frequency of intubation and intensive care unit (ICU) length of stay.
Results:
We included 135 patients (n = 71, 10 mg/kg; n = 64, 20 mg/kg). Demographics were similar except baseline CIWA, cirrhosis history, and benzodiazepine administration pre-phenobarbital were higher in the 10-mg/kg group. The incidence of severe AWS was higher in the 10-mg/kg group (56.3% vs 32.8%;
Conclusion and Relevance:
A 20-mg/kg phenobarbital dose did not reduce severe AWS but may lower benzodiazepine usage in the early withdrawal period. A 20-mg/kg dose was not associated with increased intubations. Clinicians may consider this option when crafting phenobarbital dosing regimens in patients with severe AWS.