• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN SA Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Phenobarbital vs Lorazepam in Alcohol Withdrawal
RESEARCH UPDATE

Phenobarbital vs Lorazepam in Alcohol Withdrawal

October 31, 2022
Clayton Barnes, MD
From The Carlat Addiction Treatment Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue

Barnes Clayton, MD. Dr. Barnes, author of this educational activity, has no relevant financial relationship(s) with ineligible companies to disclose.

REVIEW OF: Hawa F et al, Cureus 2021;13(2):e13282        

TYPE OF STUDY: Multisite retrospective cohort study        

Benzodiazepines such as lorazepam (Ativan) and chlordiazepoxide (Librium) have long been considered the gold standard treatment for alcohol withdrawal syndrome (AWS). However, phenobarbital may have advantages over benzodiazepines. Phenobarbital’s gradual time of onset minimizes reinforcing effects; its very long half-life (100 hours) prevents breakthrough withdrawal symptoms between doses; and it is generally safe in liver disease. Prior trials have shown that benzos and barbiturates are both effective for AWS management, but how does phenobarbital actually compare with benzos in clinical settings when it comes to length of stay (LOS)?        

This three-site, retrospective cohort study compared outcomes between patients with AWS who were treated with lorazepam versus phenobarbital. Investigators pooled 606 patients admitted for alcohol intoxication or withdrawal across three sites. The primary outcome was LOS, and secondary outcomes were 30-day readmissions (all-cause and alcohol-related), 30-day emergency department visits, and need for ICU transfer.        

543 lorazepam-treated patients and 63 phenobarbital-treated patients were included in the analysis. The two groups were similar in terms of demographics and in their medical and psychiatric comorbidities. Investigators found that the phenobarbital group had a statistically significant decrease in LOS relative to the lorazepam group (2.8 vs 3.6 days, p<0.001). The phenobarbital cohort also demonstrated a statistically significant reduction in 30-day all-cause readmissions (11% vs 14%), 30-day alcohol-related readmissions (10% vs 12%), and 30-day emergency department visits (11% vs 19%).        

There were several limitations to this study. First, there were many more patients in the lorazepam group, creating potential for systematic statistical error. The retrospective nature of the study meant that investigators could not control for preferences and biases. Severely ill patients were not included in the analysis; those requiring ICU care or addiction medicine consultation were excluded, potentially limiting the study findings to milder AWS cases. And finally, the skewed demographics (68% of the patients were male and 93% were White) might limit the generalizability of the results.        

Carlat Take        

This study suggests that phenobarbital is a reasonable alternative to lorazepam for AWS, with an added possible advantage of shorter LOS and lower 30-day readmission rates. As an already established treatment, using phenobarbital for AWS management is a reasonable consideration for inpatient settings, as long as it is managed by someone familiar with its use. 

Addiction Treatment
KEYWORDS addiction alcohol detoxification withdrawal
Clayton Barnes, MD

More from this author
www.thecarlatreport.com
Issue Date: October 31, 2022
SUBSCRIBE NOW
Table Of Contents
Trauma and Addiction
Integrating Trauma-Informed Care into Addiction Treatment
Office-Based Opioid Treatment
Phenobarbital vs Lorazepam in Alcohol Withdrawal
CME Post-Test - Trauma-Informed Care, CATR, November/December 2022
DOWNLOAD NOW
Featured Book
  • AUDFB1e_CoilBound_Graphic2_transparent_sm.png

    Treating Alcohol Use Disorder: A Fact Book (2023)

    All the tools and information needed to assess and treat your patients who are struggling with...
    READ MORE
Featured Video
  • therapist_canstockphoto9201097.jpg
    General Psychiatry

    Using SAMe In Clinical Practice with Garrett Rossi, MD

    Read More
Featured Podcast
  • Substance_Use_Sites.jpeg
    Addiction Treatment

    Supervised Drug Consumption Sites

    Once controversial, research clearly shows the benefit of these sites, and they have started opening in the United States.

    Listen now
Recommended
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png

About

  • About Us
  • CME Center
  • FAQ
  • Contact Us

Shop Online

  • Newsletters
  • Multimedia Subscriptions
  • Books
  • eBooks
  • ABPN Self-Assessment Courses

Newsletters

  • The Carlat Psychiatry Report
  • The Carlat Child Psychiatry Report
  • The Carlat Addiction Treatment Report
  • The Carlat Hospital Psychiatry Report
  • The Carlat Geriatric Psychiatry Report

Contact

info@thecarlatreport.com

866-348-9279

PO Box 626, Newburyport MA 01950

Follow Us

Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

© 2023 Carlat Publishing, LLC and Affiliates, All Rights Reserved.