title: Barbiturates for the treatment of alcohol withdrawal syndrome: A systematic review of clinical trials.
abstract: OBJECTIVE
  To perform a systematic review of the clinical trials concerning the use of barbiturates for the treatment of acute alcohol withdrawal syndrome (AWS).
  
  
  METHODS
  A literature search of MEDLINE, EMBASE, and the Cochrane Library, together with a manual citation review was conducted. We selected English-language clinical trials (controlled and observational studies) evaluating the efficacy and safety of barbiturates compared with benzodiazepine (BZD) therapy for the treatment of AWS in the acute care setting. Data extracted from the included trials were duration of delirium, number of seizures, length of intensive care unit and hospital stay, cumulated doses of barbiturates and BZDs, and respiratory or cardiac complications.
  
  
  RESULTS
  Seven studies consisting of 4 prospective controlled and 3 retrospective trials were identified. Results from all the included studies suggest that barbiturates alone or in combination with BZDs are at least as effective as BZDs in the treatment of AWS. Furthermore, barbiturates appear to have acceptable tolerability and safety profiles, which were similar to those of BZDs in patients with AWS.
  
  
  CONCLUSIONS
  Although the evidence is limited, based on our findings, adding phenobarbital to a BZD-based regimen is a reasonable option, particularly in patients with BZD-refractory AWS.
authors.affiliation: Department of Pharmacy Practice, Western New England University College of Pharmacy, 1215 Wilbraham Road, Springfield, MA 01119; Mercy Medical Center, 271 Carew Street, Springfield, MA 01104. Electronic address: yoonsun.mo@wne.edu.
authors.forename: Yoonsun
authors.initials: Y
authors.lastname: Mo
authors.affiliation: Department of Pharmacy Practice, Western New England University College of Pharmacy, 1215 Wilbraham Road, Springfield, MA 01119. Electronic address: michael.thomas@wne.edu.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Thomas
authors.affiliation: Mercy Medical Center, 271 Carew Street, Springfield, MA 01104. Electronic address: George.Karras@sphs.com.
authors.forename: George E
authors.initials: GE
authors.lastname: Karras
mesh_terms: D000430:Alcohol Withdrawal Delirium / Q000534:rehabilitation; D001463:Barbiturates / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D002985:Clinical Protocols; D002986:Clinical Trials as Topic; D003422:Critical Care; D003693:Delirium / Q000188:drug therapy; D004359:Drug Therapy, Combination; D000431:Ethanol / Q000009:adverse effects*; D006801:Humans; D007902:Length of Stay; D011446:Prospective Studies; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000534:rehabilitation*
chemical_list: D001463:Barbiturates; D001569:Benzodiazepines; D000431:Ethanol
keywords: Alcohol withdrawal syndrome; Barbiturates; Benzodiazepines; Delirium tremens; Phenobarbital; Systematic review