Alcohol Withdrawal — Phenobarbital vs Ativan for Alcohol Withdrawal in the Intensive Care Unit
Citation(s)
Askgaard G, Hallas J, Fink-Jensen A, Molander AC, Madsen KG, Pottegård A Phenobarbital compared to benzodiazepines in alcohol withdrawal treatment: A register-based cohort study of subsequent benzodiazepine use, alcohol recidivism and mortality. Drug Alcohol Depend. 2016 Apr 1;161:258-64. doi: 10.1016/j.drugalcdep.2016.02.016. Epub 2016 Feb 18.
Crispo AL, Daley MJ, Pepin JL, Harford PH, Brown CV Comparison of clinical outcomes in nonintubated patients with severe alcohol withdrawal syndrome treated with continuous-infusion sedatives: dexmedetomidine versus benzodiazepines. Pharmacotherapy. 2014 Sep;34(9):910-7. doi: 10.1002/phar.1448. Epub 2014 Jun 5.
Duby JJ, Berry AJ, Ghayyem P, Wilson MD, Cocanour CS Alcohol withdrawal syndrome in critically ill patients: protocolized versus nonprotocolized management. J Trauma Acute Care Surg. 2014 Dec;77(6):938-43. doi: 10.1097/TA.0000000000000352.
Friedmann PD Alcohol use in adults. N Engl J Med. 2013 Apr 25;368(17):1655-6. doi: 10.1056/NEJMc1302445.
Gashlin LZ, Groth CM, Wiegand TJ, et al Comparison of alcohol withdrawal outcomes in patients treated with benzodiazepines alone versus adjunctive phenobarbital: a retrospective cohort study. Asia Pac J Med Toxicol 2015;4:31-6.
Gold JA, Rimal B, Nolan A, Nelson LS A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens. Crit Care Med. 2007 Mar;35(3):724-30.
Hack JB, Hoffmann RS, Nelson LS Resistant alcohol withdrawal: does an unexpectedly large sedative requirement identify these patients early? J Med Toxicol. 2006 Jun;2(2):55-60.
Hendey GW, Dery RA, Barnes RL, Snowden B, Mentler P A prospective, randomized, trial of phenobarbital versus benzodiazepines for acute alcohol withdrawal. Am J Emerg Med. 2011 May;29(4):382-5. doi: 10.1016/j.ajem.2009.10.010. Epub 2010 Mar 25.
Ibarra F Jr Single dose phenobarbital in addition to symptom-triggered lorazepam in alcohol withdrawal. Am J Emerg Med. 2020 Feb;38(2):178-181. doi: 10.1016/j.ajem.2019.01.053. Epub 2019 Jan 30.
Ives TJ, Mooney AJ 3rd, Gwyther RE Pharmacokinetic dosing of phenobarbital in the treatment of alcohol withdrawal syndrome. South Med J. 1991 Jan;84(1):18-21.
Kaim SC, Klett CJ, Rothfeld B Treatment of the acute alcohol withdrawal state: a comparison of four drugs. Am J Psychiatry. 1969 Jun;125(12):1640-6.
Kosten TR, O'Connor PG Management of drug and alcohol withdrawal. N Engl J Med. 2003 May 1;348(18):1786-95. Review.
Kramp P, Rafaelsen OJ Delirium tremens: a double-blind comparison of diazepam and barbital treatment. Acta Psychiatr Scand. 1978 Aug;58(2):174-90.
Miller NS, Gold MS Management of withdrawal syndromes and relapse prevention in drug and alcohol dependence. Am Fam Physician. 1998 Jul;58(1):139-46. Review. Erratum in: Am Fam Physician 1998 Sep 15;58(4):866.
Mo Y, Thomas MC, Karras GE Jr Barbiturates for the treatment of alcohol withdrawal syndrome: A systematic review of clinical trials. J Crit Care. 2016 Apr;32:101-7. doi: 10.1016/j.jcrc.2015.11.022. Epub 2015 Dec 8. Review.
Saitz R, Friedman LS, Mayo-Smith MF Alcohol withdrawal: a nationwide survey of inpatient treatment practices. J Gen Intern Med. 1995 Sep;10(9):479-87.
Sarff M, Gold JA Alcohol withdrawal syndromes in the intensive care unit. Crit Care Med. 2010 Sep;38(9 Suppl):S494-501. doi: 10.1097/CCM.0b013e3181ec5412.
Wong A, Benedict NJ, Lohr BR, Pizon AF, Kane-Gill SL Management of benzodiazepine-resistant alcohol withdrawal across a healthcare system: Benzodiazepine dose-escalation with or without propofol. Drug Alcohol Depend. 2015 Sep 1;154:296-9. doi: 10.1016/j.drugalcdep.2015.07.005. Epub 2015 Jul 16.
Interventional studies are often prospective and are specifically tailored to evaluate direct impacts of treatment or preventive measures on disease.
Observational studies are often retrospective and are used to assess potential causation in exposure-outcome relationships and therefore influence preventive methods.
Expanded access is a means by which manufacturers make investigational new drugs available, under certain circumstances, to treat a patient(s) with a serious disease or condition who cannot participate in a controlled clinical trial.
Clinical trials are conducted in a series of steps, called phases - each phase is designed to answer a separate research question.
Phase 1: Researchers test a new drug or treatment in a small group of people for the first time to evaluate its safety, determine a safe dosage range, and identify side effects.
Phase 2: The drug or treatment is given to a larger group of people to see if it is effective and to further evaluate its safety.
Phase 3: The drug or treatment is given to large groups of people to confirm its effectiveness, monitor side effects, compare it to commonly used treatments, and collect information that will allow the drug or treatment to be used safely.
Phase 4: Studies are done after the drug or treatment has been marketed to gather information on the drug's effect in various populations and any side effects associated with long-term use.