title: Oral phenobarbital loading: a safe and effective method of withdrawing patients with headache from butalbital compounds.
abstract: BACKGROUND
  The overuse of short-acting barbiturate medications for the acute treatment of headache is a common problem in the United States. Most experts agree that withdrawal from these medications is necessary for subsequent headache treatment to be successful, yet there are few published articles outlining effective methods of drug withdrawal.
  
  
  OBJECTIVE
  To evaluate the safety and effectiveness of phenobarbital loading for withdrawal from overuse of short-acting barbiturate compounds in inpatients with headache.
  
  
  METHODS
  We performed a retrospective chart review of 18 consecutive patients in an inpatient pain rehabilitation program who were withdrawn from overuse of butalbital-combination medications using a phenobarbital-loading protocol.
  
  
  RESULTS
  Eighteen patients with headache hospitalized in an inpatient pain unit for withdrawal from overuse of combination butalbital preparations underwent a phenobarbital-loading protocol. Short-acting barbiturate medications were discontinued, and patients received 120 mg of oral phenobarbital until their score on a predetermined scale reached target levels, and the drug was then discontinued. All patients were effectively treated with no serious adverse events. The median number of doses required varied significantly, and could not be predicted by the patient's prior intake.
  
  
  CONCLUSIONS
  Management of butalbital withdrawal can be simplified by using a phenobarbital-loading protocol, taking advantage of the natural tapering afforded by the drug's long half-life. This method possesses most of the characteristics of an ideal drug withdrawal program for patients with headache who are overusing medications.
authors.affiliation: Headache and Pain Management Program, The Spaulding Rehabilitation Hospital, Boston, Mass 02114, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Loder
authors.forename: David
authors.initials: D
authors.lastname: Biondi
mesh_terms: D000284:Administration, Oral; D001463:Barbiturates / Q000009:adverse effects*; D001521:Behavior Therapy; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D020773:Headache Disorders / Q000139:chemically induced* / Q000188:drug therapy; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects*; D007297:Inpatients; D010634:Phenobarbital / Q000008:administration & dosage*; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy* / Q000628:therapy
chemical_list: D001463:Barbiturates; D006993:Hypnotics and Sedatives; C004470:butalbital; D010634:Phenobarbital