title: Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo-controlled study.
abstract: BACKGROUND
  Acute alcohol withdrawal syndrome (AAWS) is encountered in patients presenting acutely to the Emergency Department (ED) and often requires pharmacologic management.
  
  
  OBJECTIVE
  We investigated whether a single dose of intravenous (i.v.) phenobarbital combined with a standardized lorazepam-based alcohol withdrawal protocol decreases intensive care unit (ICU) admission in ED patients with acute alcohol withdrawal.
  
  
  METHODS
  This was a prospective, randomized, double-blind, placebo-controlled study. Patients were randomized to receive either a single dose of i.v. phenobarbital (10 mg/kg in 100 mL normal saline) or placebo (100 mL normal saline). All patients were placed on the institutional symptom-guided lorazepam-based alcohol withdrawal protocol. The primary outcome was initial level of hospital admission (ICU vs. telemetry vs. floor ward).
  
  
  RESULTS
  There were 198 patients enrolled in the study, and 102 met inclusion criteria for analysis. Fifty-one patients received phenobarbital and 51 received placebo. Baseline characteristics and severity were similar in both groups. Patients that received phenobarbital had fewer ICU admissions (8% vs. 25%, 95% confidence interval 4-32). There were no differences in adverse events.
  
  
  CONCLUSIONS
  A single dose of i.v. phenobarbital combined with a symptom-guided lorazepam-based alcohol withdrawal protocol resulted in decreased ICU admission and did not cause increased adverse outcomes.
authors.affiliation: Department of Emergency Medicine, Alameda County Medical Center/Highland Hospital, 1411 E. 31st Street, Oakland, CA 94602, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosenson
authors.forename: Carter
authors.initials: C
authors.lastname: Clements
authors.forename: Barry
authors.initials: B
authors.lastname: Simon
authors.forename: Jules
authors.initials: J
authors.lastname: Vieaux
authors.forename: Sarah
authors.initials: S
authors.lastname: Graffman
authors.forename: Farnaz
authors.initials: F
authors.lastname: Vahidnia
authors.forename: Bitou
authors.initials: B
authors.lastname: Cisse
authors.forename: Joseph
authors.initials: J
authors.lastname: Lam
authors.forename: Harrison
authors.initials: H
authors.lastname: Alter
mesh_terms: D000328:Adult; D020268:Alcohol-Induced Disorders, Nervous System / Q000188:drug therapy*; D000927:Anticonvulsants / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007275:Injections, Intravenous; D008140:Lorazepam / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010634:Phenobarbital / Q000008:administration & dosage*; D011446:Prospective Studies
chemical_list: D000927:Anticonvulsants; D008140:Lorazepam; D010634:Phenobarbital