Highlights
- •Phenobarbital is an alternative to benzodiazepines for alcohol withdrawal syndrome.
- •Phenobarbital monotherapy without benzodiazepines, may be effective and safe.
- •Future prospective RCT should be performed to standardize dosing and outcomes.
Abstract
Background
Phenobarbital (PB) has been acknowledged among clinicians as a potential alternative
to benzodiazepines (BZD) to decrease the need for hospital length of stay and complications
associated with alcohol withdrawal syndrome (AWS). However, the level of evidence,
including appropriate dosing, is unclear. We aim to summarize the evidence regarding
PB used in AWS and provide future agendas for research.
Methods
Following the PRISMA guidelines, we searched MEDLINE, EMBASE, ClinicalTrials.gov,
and WHO ICTRP for all peer-reviewed articles and clinical trials using keywords including“alcohol
withdrawal”, “delirium tremens”, “phenobarbital,” and “barbiturate” from their inception
to September 18, 2022.
Results
We included 20 articles, nine in the emergency department (ED) and 11 in the general
floors or intensive care units (ICUs). Studies performed in the ED included two RCTs,
although both suffered from a considerably small sample size. Six studies done in
the general floors or ICUs compared PB and BZD monotherapy, while four compared the
utility of adjunct PB in addition to BZD compared with BZD monotherapy and one was
a database study without specific dosing information. Overall, there was considerable
heterogeneity in PB dosing, measured outcomes, and AWS severity measurement scales.
Conclusion
This systematic review summarizes the current evidence related to PB use in AWS. While
considerable heterogeneity exists among studies available, PB as monotherapy without
BZD may be a safe and effective alternative in AWS treatment. Future prospective studies
or trials should focus on the standardization of PB dosing and outcomes.
Keywords
Abbreviations:
AUD (alcohol use disorder), AWS (alcohol withdrawal syndrome), BZD (benzodiazepine), DT (delirium tremens), ED (emergency department), GABA (γ-aminobutyric acid), ICU (intensive care unit), LOS (length of stay), NMDA (N-methyl-D-aspartate), PB (phenobarbital), RCT (randomized control trial)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 17, 2023
Accepted:
March 6,
2023
Received in revised form:
February 28,
2023
Received:
January 3,
2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
