Episode 73- “Alcohol Withdrawal? Try Phenobarbital!”: Part 3: An Expert Talks


Episode Summary:

In the final part of this “Mini Grand Rounds” series,  the author of a recently-published study discusses his experience with phenobarbital

Show Notes:

Key Points:

“‘Alcohol Withdrawal? Try Phenobarbital!’: Part 3: An Expert Talks”:
– In a recently-published study entitled ‘Phenobarbital and/or benzodiazepines for recurrent alcohol withdrawal: a self-controlled, retrospective, cohort study,’ the authors specifically wanted to see which treatment was most effective for treating high-recidivism (AKA “frequent flier”) patients in alcohol withdrawal
– This study included 137 unique patients with 642 encounters (245 PHB only, 293 BZD only, and 104 combination PHB + BZD)
– They found no significant difference between the three groups for rates of admission (36.7%, 38.9%, and 46.1%, respectively) or for return within 48 hours (17.1%, 15%, and 13.5%)
– However, the combination PHB + BZD group had significantly longer ED length of stay (8.6 hours vs 6.4 and 7 hours, P <0.05). They also had significantly higher rates of ICU admission (8.6% vs 3.8% and 2.9%) and hypotension (15.4% vs 4.5% and 5.7%) compared to when PHB and BZD were used alone, despite all groups having similar CIWA scores
– This study shows that PHB monotherapy does not prevent admission or readmisssion within 48 hours- meaning that it may not be the “magic bullet” some may think it is. It also showed that it may be safe to discharge patients from the ER after they received PHB (~ 5 mg/kg IV in this study)
– This study also adds to growing evidence that combining PHB + BZD may be risky, given the two agents’ synergistic effects on the GABA-A receptor. When treating alcohol withdrawal- try to stick to one agent only
ER-Rx Episode 73

Please click HERE to leave a review of the podcast!


Leave a Reply

Your email address will not be published. Required fields are marked *

Recent Reviews/ Comments

“Love this podcast for anyone working in an ER or ICU. If you aren’t a pharmacist you will still get tons of useful information to improve your practice. Adis has a knack for finding a happy balance between explaining the pharmacokinetics and practical use for patients at the bedside. Highly recommend!”

–  NotAPharmacist, Apple Podcasts review 

“Perfect amount of knowledge in a great length to refresh ICU and ED topics. Explains concepts in an easy to understand fashion”

–  RxLaura, Apple Podcasts review

“I love listening to this podcast because I can listen to 1 or 2 on my way to work and it provides great info! As a paramedic, this podcast has really helped me understand the “why” we give certain meds.”

cresjr, Apple Podcasts review

“Ideal podcast to listen on the way to my shift. Learning points throughout!”

andmatjos, Apple Podcasts review

“I’m currently in my last year of pharmacy school […] I just happen to come across your podcast on YouTube as I was trying to find a good explanation regarding the misleading sulfa allergy in non-antibiotic sulfonamides. Your explanation was great. I can’t believe I’m only now finding out about your podcasts but please continue to make them for as long as you can. Prospective pharmacists, such as myself, really appreciate you taking the time to put such great educational content out there.”

– S.P., Pharmacy Student

“Adis does a wonderful job of gathering the evidence-based answers to the hard questions that we all get as pharmacists and putting them into a nice, neat package.”

– rebroush1, Apple Podcasts review

“This is a great podcast to listen to at work and is not too overwhelming and well put together. Highly recommended for anyone in healthcare, even outside of emergency medicine.”

Peelage, Apple Podcasts review

“Great reviews on drug-related topics with useful details on drug mechanisms, pharmacodynamics and administration considerations as well as data to support recommendations. Great for pharmacists, providers and learners!”

-JaayyZzee, Apple Podcasts review

“I found the topics very helpful. I have been recommending this show to pharmacy students and residents, who are also enjoying it.”

hvgjnfd, Apple Podcasts review

“As a PA, I found this very informative. I like that the episodes are short, making them easy to listen to on my way to and from work. Would love to hear more pediatric topics!”

-Pediatric PA, Apple Podcasts review

“Good podcast thats very informative for all healthcare providers. Very easy to listen to and enjoy.”

-Bradlley88, Apple Podcasts review