Phenobarbital for Alcohol Withdrawal: Difference between revisions
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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 and safe alternative to benzodiazepines (BZD) for the treatment of alcohol withdrawal syndrome (AWS).<ref name="Mo2016">Mo Y, Thomas MC, Karras GE. Barbiturates for the treatment of alcohol withdrawal syndrome: A systematic review of clinical trials. J Crit Care. 2016;32:101-107. doi:[https://www.doi.org/10.1016/j.jcrc.2015.11.022 10.1016/j.jcrc.2015.11.022]</ref> 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. | [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 and safe alternative to benzodiazepines (BZD) for the treatment of alcohol withdrawal syndrome (AWS).<ref name="Mo2016">Mo Y, Thomas MC, Karras GE. Barbiturates for the treatment of alcohol withdrawal syndrome: A systematic review of clinical trials. J Crit Care. 2016;32:101-107. doi:[https://www.doi.org/10.1016/j.jcrc.2015.11.022 10.1016/j.jcrc.2015.11.022]</ref> 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. | IV/IM titrated PB is the first-line outpatient medication used for treatment of AWS at the Yukon-Kuskokwim Delta Regional Hospital. Its use is favored because substantial experience has shown that it is effective, 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 == | == Evidence of Effectiveness and Safety == | ||
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Revision as of 19:33, 28 August 2019
Phenobarbital is a non-competitive gamma-Aminobutyric acid (GABA) agonist which is an equally effective and safe alternative to benzodiazepines (BZD) for the treatment of alcohol withdrawal syndrome (AWS).[1] 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. Its use is favored because substantial experience has shown that it is effective, 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 Mo et al in the Journal of Critical Care[1] concluded that "barbiturates alone or in combination with BZDs are at least as effective as BZDs in the treatment of AWS. Furthermore, barbiturates appear to have acceptable tolerability and safety profiles, which were similar to those of BZDs in patients with AWS."
References
- ↑ 1.0 1.1 Mo Y, Thomas MC, Karras GE. Barbiturates for the treatment of alcohol withdrawal syndrome: A systematic review of clinical trials. J Crit Care. 2016;32:101-107. doi:10.1016/j.jcrc.2015.11.022
