PulmCrit (EM Crit)
EM Crit - October 18, 2015 - By Josh Farkas
- "Although benzodiazepines are regarded as the mainstay of treatment for alcohol withdrawal, there has never been an adequately powered RCT comparing benzodiazepines vs. phenobarbital.
- Benzodiazepines occasionally fail to control alcohol withdrawal, and may promote agitated delirium. In contrast, phenobarbital is more effective and doesn’t cause paradoxical agitation.
- Some countries have extensive experience treating alcohol withdrawal with phenobarbital monotherapy. Available evidence supports the safety and efficacy of this approach.
- Phenobarbital monotherapy consists of a gradual dose titration as shown below. Once a therapeutic phenobarbital level is reached, this will gradually auto-taper and provide ongoing protection from seizures or recurrent withdrawal."
