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


CONCLUSIONS
Phenobarbital and LZ were similarly effective in the treatment of mild/moderate alcohol withdrawal in the ED and at 48 hours.
Hendey
Gregory W
GW
Department of Emergency Medicine, UCSF-Fresno Medical Education Program, Community Regional Medical Center, Fresno, CA 93701-2302, USA. ghendey@fresno.ucsf.edu
Dery
Robert A
RA
Barnes
Randy L
RL
Snowden
Brandy
B
Mentler
Philippe
P
D000284:Administration, Oral; D019973:Alcohol-Related Disorders / Q000150:complications / Q000188:drug therapy*; D002707:Chlordiazepoxide / Q000008:administration & dosage*; D005260:Female; D018757:GABA Modulators / Q000008:administration & dosage*; D006801:Humans; D007275:Injections, Intravenous; D007902:Length of Stay; D008140:Lorazepam / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010634:Phenobarbital / Q000008:administration & dosage*; D011446:Prospective Studies; D012008:Recurrence; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
D018757:GABA Modulators; D002707:Chlordiazepoxide; D008140:Lorazepam; D010634:Phenobarbital