Phenobarbital for Alcohol Withdrawal: Difference between revisions

Revision as of 18:55, 28 August 2019

Phenobarbital is a non-competitive gamma-Aminobutyric acid (GABA) agonist which is an equally effective alternative to benzodiazepines (BZD) for the treatment of alcohol withdrawal syndrome (AWS). Though its use for AWS has waned and consequently many clinicians are now unfamiliar with this regimen, PB has both mechanistic and pharmacokinetic properties which make it more suitable for outpatient monotherapy than BZD.

IV/IM titrated PB is the first-line outpatient medication used for treatment of AWS at the Yukon-Kuskokwim Delta Regional Hospital because it minimizes return visits and it eliminates the need to dispense abuse-prone medications (i.e. BZD) to abuse-prone patients while in the midst of a substance abuse crisis. Indeed, minimizing high-risk dispensing of abuse-prone medication is important for improving the health of our community.

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 [https://en.wikipedia.org/wiki/Phenobarbital Phenobarbital] is a non-competitive [https://en.wikipedia.org/wiki/Gamma-Aminobutyric_acid gamma-Aminobutyric acid] (GABA) agonist which is an equally effective alternative to benzodiazepines (BZD) for the treatment of alcohol withdrawal syndrome (AWS).  Though its use for AWS has waned and consequently many clinicians are now unfamiliar with this regimen, PB has both mechanistic and pharmacokinetic properties which make it more suitable for outpatient monotherapy than BZD.
-IV/IM titrated PB is the first-line outpatient medication used for treatment of AWS at the Yukon-Kuskokwim Delta Regional Hospital because it minimizes return visits and it eliminates the need to dispense abuse-prone medications (i.e. BZD) to abuse-prone patients while in the midst of a substance abuse crisis.  Indeed, minimizing high-risk dispensing of abuse-prone medication is important for improving the health of the community.
+IV/IM titrated PB is the first-line outpatient medication used for treatment of AWS at the Yukon-Kuskokwim Delta Regional Hospital because it minimizes return visits and it eliminates the need to dispense abuse-prone medications (i.e. BZD) to abuse-prone patients while in the midst of a substance abuse crisis.  Indeed, minimizing high-risk dispensing of abuse-prone medication is important for improving the health of our community.
-Phenobarbital is a barbiturate which was first synthesized in 1911 and was marketed by Bayer as a sedative in 1912 under the brand name ''Luminal''.  PB's anti-seizure effects were quickly recognized in that same year, and it is now the oldest anti-seizure medication on the market.  Due to its age, a wealth of pharmacologic data exists for the drug.
-PB was first used for alcohol withdrawal syndrome (AWS) in 1912, and it has remained in use for this purpose ever since.
-PB is a GABA-agonist which has been known to be effective for treating alcohol withdrawal syndrome (AWS) since 1972.
-When PB is used for outpatient treatment of AWS, it should be titrated to effect in a monitored setting.  Patients should ''never'' be discharged with a supply of oral PB for symptom-triggered dosing.