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

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