Abstract
Background:
There is a lack of information regarding the combination therapy of phenobarbital (PB) and benzodiazepine (BZD) for the symptomatic management of patients in or at risk of severe alcohol withdrawal syndrome (AWS).
Objective:
The objective of this study was to assess the safety and efficacy of a PB loading dose in addition to symptom-triggered BZD treatment for patients in or at risk of severe AWS.
Methods:
Between January 2024 and May 2025, patients treated for AWS were screened for inclusion. Criteria for inclusion were age of at least 18 years old, a Prediction of Alcohol Withdrawal Severity Scale (PAWSS) score of 4 or higher, and a record of receiving treatment for AWS. Patients were excluded from the study if they were directly admitted to the intensive care unit (ICU) or psychiatric service, transferred to the ICU within 12 hours of admission, or with a length of stay less than 24 hours. The primary endpoint was the difference in cumulative BZD requirements. Secondary endpoints included the need for adjunct therapies, incidence of adverse events, and escalation of care.
Results:
The final analysis included 75 patients in the BZD group and 63 patients in the PB group. There was a statistically significant decrease in the cumulative BZD utilization in the PB loading group. Patients who exclusively received BZD therapy for AWS used an average of 148 mg of diazepam equivalents versus 112 mg in the PB group (P = 0.002). The PB group was also associated with a statistically significant reduction in the incidence of hypotension, respiratory depression, and the need for adjunct therapies.
Conclusions and relevance:
The addition of a weight-based PB loading dose showed a significant reduction in BZD utilization for patients in or at risk of severe AWS and was associated with fewer adverse events. Application of this information may aid in enhancing treatment for patients in or at risk of severe AWS.
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