Back to Search
Start Over
Impact of a Divided Phenobarbital Load and Taper Compared With Lorazepam Symptom Triggered Therapy in Hospitalized Patients.
- Source :
-
The Annals of pharmacotherapy [Ann Pharmacother] 2024 Sep; Vol. 58 (9), pp. 896-905. Date of Electronic Publication: 2024 Jan 23. - Publication Year :
- 2024
-
Abstract
- Background: Benzodiazepines are the preferred treatment for alcohol withdrawal. Phenobarbital is an alternative in the setting of prescriber expertise or benzodiazepine contraindication.<br />Objective: To evaluate the efficacy and safety of a phenobarbital dosing strategy aimed at treating a spectrum of alcohol withdrawal symptoms across various patient populations.<br />Methods: Retrospective review of patients admitted with concerns of alcohol withdrawal between May 2018 and November 2022. Patients were separated into a before-after cohort of lorazepam or phenobarbital. The primary outcome was hospital length of stay (LOS). Secondary outcomes were intensive care unit (ICU) LOS, escalation of respiratory support, increased level of care (LOC), and incidence of delirium tremens and/or seizures.<br />Results: Two hundred and seventy-seven patients received lorazepam and 198 received phenobarbital. Hospital LOS was longer in the phenobarbital cohort compared with the lorazepam cohort (6.9 vs 9.3 days). There was no difference in ICU LOS. Level of care increases were fewer in the phenobarbital cohort (4 events vs 19 events). There were higher rates of non-invasive respiratory interventions in the lorazepam cohort and higher rates of mechanical ventilation in the phenobarbital cohort. Utilization of phenobarbital was attributed to a reduction in delirium tremens and seizures.<br />Conclusion and Relevance: This study is novel because of the broad application of a phenobarbital order set across multiple levels of care and patient admission diagnoses. A risk targeted split load intravenous phenobarbital order set can safely be administered to patients with fewer escalations of care, seizures, delirium tremens, and respiratory care escalation.<br />Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Subjects :
- Humans
Male
Retrospective Studies
Female
Middle Aged
Adult
Aged
Hospitalization statistics & numerical data
Intensive Care Units
Hypnotics and Sedatives administration & dosage
Hypnotics and Sedatives adverse effects
Hypnotics and Sedatives therapeutic use
Alcohol Withdrawal Delirium drug therapy
Substance Withdrawal Syndrome drug therapy
Seizures drug therapy
Respiration, Artificial
Phenobarbital administration & dosage
Phenobarbital therapeutic use
Lorazepam administration & dosage
Lorazepam therapeutic use
Length of Stay
Subjects
Details
- Language :
- English
- ISSN :
- 1542-6270
- Volume :
- 58
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- The Annals of pharmacotherapy
- Publication Type :
- Academic Journal
- Accession number :
- 38258797
- Full Text :
- https://doi.org/10.1177/10600280231222294