Patients With Severe Alcohol Withdrawal May Benefit From Phenobarbital, Study Suggests

Phenobarbital, a long-acting barbiturate, may be an effective alternative to benzodiazepines for the treatment of severe alcohol withdrawal symptoms such as hallucinations and seizures, according to a study published in Psychosomatics.

“Considerable data exist on the effectiveness of benzodiazepines for the management of [alcohol withdrawal syndrome],” wrote Mladen Nisavic, M.D., of Massachusetts General Hospital and colleagues. However, since benzodiazepines target the same receptors as alcohol, some people with chronic heavy alcohol use may have developed a tolerance to benzodiazepines in addition to a tolerance to alcohol, the authors noted. In addition, benzodiazepines may pose health risks for some patients, including those with respiratory problems.

Nisavic and colleagues conducted a retrospective assessment on all patients admitted to Massachusetts General Hospital between July 2007 and July 2011 who received either phenobarbital or a benzodiazepine for alcohol withdrawal syndrome. They identified 419 patients who received a benzodiazepine and 143 who received phenobarbital treatment; 16 of the patients who initially received a benzodiazepine were subsequently switched to phenobarbital while one patient was transitioned from phenobarbital to a benzodiazepine.

The patients who started on phenobarbital were significantly more likely to have a history of documented alcohol withdrawal syndrome compared with those started on benzodiazepines (91% vs. 73%); phenobarbital patients were also more likely to have a history of withdrawal-related seizures (73% vs. 45%) and/or present with a seizure on arrival to the hospital (14% vs. 7%).

Despite having more health complications related to alcohol withdrawal, the patients given phenobarbital showed similar treatment outcomes—which included rates of seizures, hallucinations, delirium, or admission to an intensive care unit—as patients given a benzodiazepine. Furthermore, the 16 patients initially treated with a benzodiazepine but then transitioned to phenobarbital showed significantly better outcomes following the switch.

“Given the concordance of our data and the literature, it appears that phenobarbital is a feasible alternative for [alcohol withdrawal syndrome] management, especially in patients with prior known complex [alcohol withdrawal syndrome], and in patients who fail to respond to conventional [benzodiazepine]-based treatment,” Nisavic and colleagues wrote.

For related information, see the Psychiatric News article “APA Releases Practice Guideline for AUD Pharmacotherapy.”

(Image: iStock/Pornpak Khunatorn)

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