47-Comparison of Two Dosing Strategies of Phenobarbital for Alcohol Withdrawal Syndrome
Back to course
Video Transcription
Video Summary
Asset Subtitle
Pharmacology, Behavioral Health and Well Being, 2021
Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Pansy Elsamadisi


Introduction/Hypothesis: Phenobarbital (PHB) has been studied for the management of alcohol withdrawal syndrome (AWS), but the optimal dosing regimen for AWS is unknown. Given the long half-life of PHB, it auto-tapers, suggesting that a single loading dose of PHB may provide AWS symptom control for several days. The purpose of this study is to compare two different dosing strategies (loading dose only vs. loading dose followed by a 7 day taper) with respect to the need for rescue medications.

Methods: This was a retrospective pre-post analysis performed at a tertiary-care academic medical center to evaluate patients admitted to the intensive care unit (ICU) who received PHB for AWS. Patients who were ordered a loading dose (10 mg/kg) and taper (7 days) were in the PRE group. Following implementation of a hospital protocol, patients who were ordered for only a loading dose consisted of the POST group. Patients in both groups were able to receive rescue PHB up to a total cumulative dose of 15 mg/kg, along with adjunctive medications for AWS. The primary outcome was the proportion of patients requiring adjunctive medications after the initial PHB dose. Secondary outcomes included type of adjunctive medications used, ICU and hospital length of stay (LOS).

Results: A total of 122 patients were included in this study (PRE: n=60; POST: n=62). Patients in the PRE group were significantly older than in those in the POST group (56 vs. 48, p=0.0004). The median cumulative PHB dose in the PRE group was 908 mg (IQR 585-880), compared to 715 mg (IQR 689-1081) in the POST group (p<0.001). There was no difference in the need for rescue adjunctive medications between the PRE and POST groups (55 vs. 61%, p=0.71). There was also no difference in types of adjunctive medications used between the two groups for AWS, except for a significantly higher use of hydroxyzine in the POST group (p=0.006). There were no significant differences in ICU or hospital LOS.

Conclusions: The use of a PHB taper, in addition to a loading dose, did not result in decreased use of adjunctive medications for AWS, compared to a no-taper regimen. The results of this study support the use of only a loading dose of phenobarbital to manage AWS.


Meta Tag
Content Type Presentation
Knowledge Area Pharmacology
Knowledge Area Behavioral Health and Well Being
Knowledge Level Advanced
Membership Level Select
Tag Alcohol and Substance Abuse
Year 2021
dosing strategies
Alcohol Withdrawal Syndrome
loading dose
weight-based tapered regimen


Society of Critical Care Medicine

500 Midway Drive
Mount Prospect, IL 60056 USA

Phone: +1 847 827-6888
Fax: +1 847 439-7226
Email: support@sccm.org

Contact Us

About SCCM


Advertising & Sponsorship




Patients & Families

Surviving Sepsis Campaign

Critical Care Societies Collaborative

kisspng-facebook-social-media-computer-icons-linkedin-soci-gray-5ac493cf1c2975.7867418415228323351154  - KW Symphony    Gray twitter 3 icon - Free gray social icons    Gray linkedin 3 icon - Free gray site logo icons    Gray instagram icon - Free gray social icons    YouTube Icon Gray Box - HONOR VETERANS NOW


© Society of Critical Care Medicine. All rights reserved.   |    Privacy Statement    |    Terms & Conditions
The Society of Critical Care Medicine, SCCM, and Critical Care Congress are registered trademarks of the Society of Critical Care Medicine.

Android App Download IOS App Download Powered By