Phenobarbital for Alcohol Withdrawal

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.

Evidence of Effectiveness and Safety

A 2016 systematic review by Yoonsun et al in the Journal of Critical Care concluded that "barbiturates alone or in combination with BZDs are at least as effective as BZDs in the treatment ofAWS. Furthermore, barbiturates appear to have acceptable tolerability and safety profiles, which were similar to those of BZDs in patients with AWS."