Use of Phenobarbital in Delirium Tremens

Abstract

The standard of care for alcohol withdrawal centers on the use of escalating doses of benzodiazepines until clinical improvement is achieved. However, there is no established standard in the care of patients with severe alcohol withdrawal and delirium tremens that is refractory to benzodiazepine therapy. One potential therapy that is gaining traction is the use of phenobarbital, which may be mechanistically superior to benzodiazepines in treating delirium tremens because of its effects on GABA and N-methyl-D-aspartate receptors. The dosing of phenobarbital and its subsequent taper, however, is still unclear and the side effect profile is not well characterized. In this case report, we present the case of a 37-year-old Hispanic male who presented with alcohol withdrawal and subsequent delirium tremens who was treated with phenobarbital with positive clinical response and minimal side effects.

Adjuvant Trazodone for Management of Protracted Delirium Tremens

“…Previous studies on refractory DT used barbiturates, propofol, antipsychotics, etc., to manage DT, but also reported serious complications with these medications. 4 , 6 As our patient was not very agitated and his sleep was disrupted, we decided to improve his sleep first and added trazodone. Trazodone has been found to reduce the need for BZDs in patients with alcohol withdrawal.…”

Yes! Mass Spec Has Interferences

“…In today's environment of the opioid crisis, more physicians are turning to off-label uses for antiseizure medications (e.g., oxcarbazepine, carbamazepine, phenobarbital) (2) to aid in treating opioid and alcohol addiction. With this class of drug back on the rise for use in both treatment and abuse (2,3,4), it is important for the laboratory to understand the limitations of our testing. In my own lab, I have seen concentrations in both drugs of abuse and treatment that were unheard of just 5 years ago.…”