Adjunctive Phenobarbital for Alcohol Withdrawal Syndrome: A Focused Literature Review

Murphy, Julie A.; Curran, Brittany M.; Gibbons, William A.; Harnica, Holly M.

doi:10.1177/1060028021999821

Cited by 11 publications

(4 citation statements)

References 17 publications

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“…Despite warnings from the World Health Organization, alcohol consumption is expected to increase until at least 2025. Hospital admissions for chronic alcohol abusers are particularly dangerous since these patients are at an increased risk of developing life-threatening conditions such as alcohol withdrawal syndrome (AWS) [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Phenobarbital and Alcohol Withdrawal Syndrome: A Systematic Review and Meta-Analysis

Umar¹,

Rasool²,

Shoaib³

et al. 2023

Cureus

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Alcohol withdrawal syndrome (AWS) is a complication frequently encountered among patients who are chronic alcohol abusers. It is considered to have a significant impact on the United States healthcare system.It not only has a toll on the healthcare spending but also contributes to significant morbidity and mortality. Benzodiazepines are considered first line in the treatment of AWS. Since patients with alcohol use disorder have downregulated gamma aminobutyric acid (GABA) receptors, this often leads to benzodiazepine resistance. Phenobarbital is also used in the management of alcohol withdrawal syndrome. Here we present a systematic review and meta-analysis of the efficacy and safety of the drug.We conducted an electronic database search for relevant studies published between the inception of the project and November 20, 2022, in three databases, including Medline/PubMed, Embase, and Cochrane Library. Our study included all original studies with prime focus on the baseline characteristics of patients admitted to the intensive care unit (ICU) for alcohol withdrawal syndrome and management/monitoring protocol implemented for its treatment. The primary outcomes that were the focus of our study consisted of changes in the length of hospital stay, length of ICU stay, and changes in scoring systems (for alcohol withdrawal assessment and monitoring) following the implementation of phenobarbital. The secondary outcomes included complications such as intubation and mortality.Based on our analysis, the mean difference in hospital stay was statistically significant at -2.6 (95% CI, -4.48, -0.72, P=0.007) for phenobarbital compared to the benzodiazepine group. We were unable to comment on the heterogeneity in our meta-analysis due to the standard deviation not being reported in one study. There was no statistically significant difference regarding the length of stay in the intensive care unit compared to the control/comparative arm, with a mean difference of -1.17 (95% CI, -1.17, 0.09, P=0.07), with considerable heterogeneity (I 2 =77%, P=0.002). Our meta-analysis also investigated the risk of intubation between the phenobarbital and the control/comparative group. There was statistically significant difference in the incidence of intubation, relative risk (RR) 0.52 (95% CI, 0.25, 1.08, P=0.08), with considerable heterogeneity (I 2 =80%, P=0.0001).Our study concludes that phenobarbital is an effective tool in the management of AWS in an ICU setting. However, various studies have reported contradictory results, and vital information appears to be lacking. Moreover, there is a lack of uniformity in terms of phenobarbital dosing. Drug administration should be adapted according to the severity of the symptoms. Further studies need to be conducted discussing the safety profile and adverse effects of the drug when it comes to the management of alcohol withdrawal syndrome.

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Section: Introductionmentioning

confidence: 99%

Phenobarbital and Alcohol Withdrawal Syndrome: A Systematic Review and Meta-Analysis

Umar¹,

Rasool²,

Shoaib³

et al. 2023

Cureus

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“…Benzodiazepines are the standard of care for treating alcohol withdrawal syndrome (AWS), but there is growing interest in the United States in re‐utilizing the long‐acting barbiturate, phenobarbital (PB) as an adjunctive or primary medication in severe cases. This is due to PB's potentially favorable pharmacodynamic properties compared to benzodiazepines [1], and a high‐impact 2013 trial demonstrated reduced intensive care unit (ICU) admissions with PB administration in the emergency department (ED) [2]. We found that since then (2013–22) there has been a sixfold (PubMed®) to 11‐fold (Google Scholar™) increase in publications on the topic compared to the prior decade (2003–12).…”

Section: Figurementioning

confidence: 99%

Phenobarbital for alcohol withdrawal in the context of the opioid epidemic: a neglected caveat

et al. 2023

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“…Препарати бензодіазепінового ряду є пріоритетними для забезпечення належного її рівня [10]. Багато досліджень повідомляють, що в людей з великим стажем зловживання алкоголю та з наявними попередніми епізодами делірію, формується так званий синдром резистентності до бензодіазепінів [8]. Додаткове використання барбітуратів часто призводить до розвитку гіпотонії та дихальних розладів [7].…”

Section: вступunclassified

Comparative characteristics of ketamine and sodium oxybutyrate as adjuvant sedation in patients with alcoholic delirium

Havrylov¹,

Гомон²,

Slobodyanyuk³

et al. 2021

Rep. of Vinnytsia Nation. Med. Univ.

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Annotation. Today, the number of benzodiazepine-resistant alcoholic deliriums is growing. It is actually to search for an optimal scheme of sedation with a combination of two sedatives. The aim of the study was to compare efficacy of standard sedation with added barbiturates and the schemes with using ketamine and sodium oxybutyrate. We tested 60 cases of delirium tremens which were randomized into three groups. In the control group we conducted the traditional sedation with added sodium thiopental. In the first research group we combined the infusion of ketamine with diazepam. In the second one we gave sodium oxybutyrate with diazepam. We evaluated the duration of delirium, hemodynamics parameters, serum cortisol and serotonin, laboratory indicators of kidneys and liver condition. We used such statistical methods as Mann-Whitney test, Wilcoxon T-criterion and Kruskal-Wallis H-criterion. The duration of delirium was significantly lower in research groups in comparison with the control one. There was no difference of the duration of delirium between research groups. It indicates a comparable effect of using either ketamine, or sodium oxybutyrate. All groups showed significant reduction of hemodynamics parameters in the process of the treatment, however we observed more cases of hypertension and tachycardia on the third day of the treatment in the research groups than in the control one. These data suggest an insufficient effect of the combination of diazepam with both ketamine and sodium oxybutyrate on the sympatho-adrenal system. Serum cortisol was significantly reduced in all the groups, there was no difference between control and research groups. Serotonin was equally increased in all the groups on the third day. The obtained results indicate that the effectiveness of the combination of benzodiazepines with both ketamine and sodium oxybutyrate is comparable to the standard sedation regimen and does not differ in the reaction of these biomarkers. The laboratory indicators of kidneys condition on the third day increased only in the research groups, which indicates more negative influence on kidneys by both ketamine and sodium oxybutyrate. The indicators of liver condition were significantly reduced only in the group of ketamine, there were no difference in the rest groups. The use of ketamine and sodium oxybutyrate as adjuvant sedation may reduce the duration of a delirium episode, but has insufficient effect on hemodynamics and may adversely affect renal function.

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Adjunctive Phenobarbital for Alcohol Withdrawal Syndrome: A Focused Literature Review

Cited by 11 publications

References 17 publications

Phenobarbital and Alcohol Withdrawal Syndrome: A Systematic Review and Meta-Analysis

Phenobarbital and Alcohol Withdrawal Syndrome: A Systematic Review and Meta-Analysis

Phenobarbital for alcohol withdrawal in the context of the opioid epidemic: a neglected caveat

Comparative characteristics of ketamine and sodium oxybutyrate as adjuvant sedation in patients with alcoholic delirium

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