Phenobarbital safe, effective for alcohol withdrawal syndrome in psychiatric inpatients

Use of phenobarbital is effective for the prevention and treatment of alcohol withdrawal syndrome (AWS) in psychiatric inpatients, a study has shown. Moreover, it is safe and neither leads to severe adverse effects nor requires a higher level of care.

The investigators conducted this single-centre, retrospective, observational study to describe the potential role of phenobarbital as therapy for the management of AWS among medically cleared psychiatric inpatients.

A total of 122 adult patients admitted to the psychiatric unit and administered phenobarbital were included in the analysis. Changes in vital signs and signs and symptoms of AWS were observed to evaluate the safety and efficacy of the study drug. Safety, the primary outcome, was measured by change in the respiratory rate (RR).

No significant changes in RR were observed among patients who received phenobarbital for the prevention and treatment of AWS. On the other hand, blood pressure and heart rate were significantly decreased.

Ninety-four percent of patients with documented signs and symptoms of AWS upon admission showed improvements during phenobarbital therapy. Nearly 12 percent of patients had documented sedation or altered mental status during treatment, but none required transfer to a medical or critical care unit.

In general medical patients, use of phenobarbital was also effective and safe, as shown by the results of a 2019 study by Nisavic and colleagues. Patients initiated on phenobarbital had similar outcomes to those on benzodiazepine treatment, which is the standard of care for the management of AWS. [Psychosomatics 2019;60:458-467]