Doctors may prescribe phenobarbital to treat AWS and reduce the risk of life threatening complications. We’ll outline alcohol use disorder (AUD) and its relation to AWS and describe how phenobarbital helps to treat AWS. Alcohol withdrawal syndrome (AWS) can occur when you stop or limit alcohol use after a period of prolonged and heavy use.

• In the post-guideline era, patients admitted to the ICU for the management of AWS were administered benzodiazepine and phenobarbital in a protocolized manner 17.
• The data that support the findings of this study are openly available as an Appendix S1.
• The American Society of Addiction Medicine’s 2020 Clinical Practice Guidelines recommend benzodiazepines as the first-line treatment for addiction 4.

Associated Data

On the NIH tool, the case series included in our study received an overall score of 8 out of 9 10. Levels 1 and 2 are the least severe and typically do not require a stay at a recovery facility. Levels 3 and 4 involve more dangerous and require at least a part-time stay at an inpatient facility. Moreover, people who experience alcohol withdrawal seizures are at increased risk of developing recurrent seizures. Phenobarbital has many risks for side effects and interference with other medications. It’s typically not used for long periods of time and only under the supervision of specialized healthcare professionals.

PATIENTS:

All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus. That said, its use is limited to those with severe symptoms who are undergoing inpatient care. Symptoms are usually mild and may include mild anxiety, cutting back on alcohol symptoms headaches, and insomnia.

Data Availability Statement

A few participants in the case series conducted by Ammar et al. received quetiapine, haloperidol, or a combination of the two for the management of alcohol withdrawal syndrome 10. Patients requiring mechanical ventilation in the study conducted by Gold et al. received propofol 17. Goodberlet et al. conducted a study where a few of the participants in both control and experimental arms received dexmedetomidine, clonidine, propofol, and antipsychotics 13. A total of 11 patients in the experimental group and 26 patients in the control group received propofol and dexmedetomidine for the management of alcohol withdrawal syndrome in the study conducted by Saukkonen et al. 18.

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

This syndrome happens because of alcohol-induced changes to the brain’s neurochemistry over time. The data that support the findings of this study are openly available as an Appendix S1. This section collects any data citations, data availability statements, or supplementary materials included in this article.

• Overall, this study demonstrates that phenobarbital may serve as a promising alternative to benzodiazepine‐based treatment for AWS.
• Adjunct medications administered included haloperidol, dexmedetomidine, and quetiapine.

After removing duplicate records and Twelve-step program manually screening abstracts and titles, 21 records were identified for further full-text screening. Two studies were excluded due to the data being individualized for every patient and lack of mean/median values of the variables examined for the entire study population. Ultimately, nine studies were included in this systematic review and meta-analysis after 12 papers were excluded from the full-text screening phase (Figure 1). The National Institute on Alcohol Abuse and Alcoholism (NIAAA)9 reports that approximately 16 million people in the United States have AUD and are therefore at increased risk of developing AWS. AWS can occur as early as 6 h and may persist for up to 7 days after alcohol cessation.

• Phenobarbital has many risks for side effects and interference with other medications.
• Finally, the use of CIWA-Ar in the MICU has been subject to debate in the literature, as it relies on patient cooperation (27).
• Since some vital details are lacking in the included studies, it is important to mention the need for large-scale, multi-center studies to be conducted before solid conclusions and recommendations can be made.
• Chronic alcoholism leads to a decrease in gamma aminobutyric acid (GABA) inhibitory receptors as part of a feedback mechanism to counteract the depressive effects of alcohol.

1. Study design, setting, and patient population

However, AWS can sometimes cause severe and potentially life threatening symptoms, such as delirium and seizures. Rapidly escalating doses of PB over a short period are an effective and safe alternative to BZD in treating AWS in MICUs. Doctors will taper the phenobarbital dosage over time to reduce the risks of phenobarbital withdrawal. These cases will also typically require at least some time in a recovery facility where you can be monitored for signs of seizures or other life threatening symptoms. Kaplan-Meier curves showing the probability of (A) ICU and (B) hospital discharge over time. The blue box represents individual study effects and the black diamond represents the combined result of the studies.