Background: Alcohol withdrawal is a common issue in hospitalized patients and is associated with significant morbidity and mortality. Alcohol withdrawal occurs when the gamma aminobutyric acid (GABA) stimulating effect of alcohol is removed, resulting in an excess of the excitatory neurotransmitter glutamate. Treatment typically consists of as needed benzodiazepines, which activate GABA. However, this reactive [...]

Background: Alcohol use disorder (AUD) Is present in 10% of adults and its prevalence is increasing. When patients with AUD are admitted to the hospital, half develop alcohol withdrawal syndrome (AWS), which can cause delirium, hallucinations, seizures, and even mortality if not treated appropriately. A fixed-dose phenobarbital strategy may be superior to the standard of [...]

Background: Phenobarbital (PB) has important pharmacological advantages over benzodiazepines (BZDs) for treatment of alcohol withdrawal syndrome (AWS). The American Society of Addiction Medicine recommends PB monotherapy as an alternative to BZDs for prophylaxis or treatment of AWS by providers experienced with its use. Few studies have described the use of PB for AWS outside of [...]

Background: There are approximately 500,000 episodes of alcohol withdrawal that require pharmacologic treatment yearly. Lorazepam is commonly used due to its high therapeutic to-toxic effect index and its status as historically being the usual treatment. Phenobarbital is another common drug used to treat alcohol withdrawal. Patients with heavy alcohol use may become resistant to some [...]

Background: Patients with alcohol use disorder are at high risk of alcohol withdrawal syndrome (AWS) while hospitalized. AWS includes a wide spectrum of clinical features and is associated with significant morbidity and mortality. Pharmacologic treatment of AWS revolves around the use of benzodiazepines (BZDs) or phenobarbital (PHB). Current literature recommends symptom-triggered BZD dosing as first [...]

Background: UNC’s hospitalist service admits on average 9 patients per week with alcohol use disorder (AUD). UNC does not have a standardized inpatient screening tool for assessing risk of Alcohol Withdrawal Syndrome (AWS) nor standardized treatment protocol for AWS. In the 6 months prior to our study, 30% of inpatients at UNC with AUD in [...]

Background: Since the 1960s, benzodiazepine therapy has been the standard of care for alcohol withdrawal syndrome (AWS) [1]. Recently, phenobarbital-based withdrawal has re-emerged as a potentially safer and more effective option that can decrease admission rates when given in the emergency department (ED) [2-7]. Thus, many academic medical centers (AMCs) have switched to phenobarbital for [...]