A prospective, randomized, trial of phenobarbital versus benzodiazepines for acute alcohol withdrawal

Am J Emerg Med. 2011 May;29(4):382-5. doi: 10.1016/j.ajem.2009.10.010. Epub 2010 Mar 25.

Abstract

Objective: The aim of this study was to compare phenobarbital (PB) versus lorazepam (LZ) in the treatment of alcohol withdrawal in the emergency department (ED) and at 48 hours.

Methods: Prospectively, randomized, consenting patients were assessed using a modified Clinical Institute Withdrawal Assessment (CIWA) score and given intravenous PB (mean, 509 mg) or LZ (mean, 4.2 mg). At discharge, LZ patients received chlordiazepoxide (Librium), and PB patients received placebo.

Results: Of 44 patients, 25 received PB, and 19 LZ. Both PB and LZ reduced CIWA scores from baseline to discharge (15.0-5.4 and 16.8-4.2, P < .0001). There were no differences between PB and LZ in baseline CIWA scores (P = .3), discharge scores (P = .4), ED length of stay (267 versus 256 minutes, P = .8), admissions (12% versus 16%, P = .8), or 48-hour follow-up CIWA scores (5.8 versus 7.2, P = .6).

Conclusion: Phenobarbital and LZ were similarly effective in the treatment of mild/moderate alcohol withdrawal in the ED and at 48 hours.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Administration, Oral
  • Alcohol-Related Disorders / complications
  • Alcohol-Related Disorders / drug therapy*
  • Chlordiazepoxide / administration & dosage*
  • Female
  • GABA Modulators / administration & dosage*
  • Humans
  • Injections, Intravenous
  • Length of Stay
  • Lorazepam / administration & dosage*
  • Male
  • Middle Aged
  • Phenobarbital / administration & dosage*
  • Prospective Studies
  • Recurrence
  • Substance Withdrawal Syndrome / drug therapy*
  • Substance Withdrawal Syndrome / etiology
  • Treatment Outcome

Substances

  • GABA Modulators
  • Chlordiazepoxide
  • Lorazepam
  • Phenobarbital