Name: Simplified Phenobarbital Versus Benzodiazepine Driven CIWA-Ar Protocol for Alcohol Withdrawal Syndrome
Start: 2025-04-24T09:10:00-0400
End: 2025-04-24T09:25:00-0400

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Thursday April 24, 2025 9:10am - 9:25am EDT

Athena H

Title: Simplified Phenobarbital Versus Benzodiazepine Driven CIWA-Ar Protocol for Alcohol Withdrawal Syndrome

Authors: Hyo Min Kim, Julie Willmon, Houda Dardari

Background/Purpose: Treatment for alcohol withdrawal syndrome (AWS) targets disrupted pathways of GABA inhibition and NMDA receptor upregulation.1 According to the American Society of Addiction Medicine, benzodiazepines are first-line treatment for AWS. However, prolonged exposure to ethanol will result in tolerance to benzodiazepines.2 While benzodiazepines only work on GABA, phenobarbital offers a dual mechanism of action involving glutamate and GABA along with longer half-life for easier tapering.3 Literature suggests positive clinical outcomes from phenobarbital in AWS, but the ideal dosing is unknown.4 This study compares hospital length of stay (LOS) between a simplified phenobarbital regimen and the traditional benzodiazepine-driven CIWA protocol in patients admitted for AWS. Secondary outcomes include ICU LOS, need for adjunctive therapy, and incidence of adverse events.

Methodology: This retrospective study analyzed patients admitted for AWS at AdventHealth Winter Park from November 1, 2022, to January 31, 2025. Patients received either a simplified phenobarbital dosing strategy or a traditional benzodiazepine-driven CIWA protocol. Exclusion criteria included age <18 years, pregnancy, discharge against medical advice within 24 hours, home phenobarbital use, or a history of porphyria. The phenobarbital regimen involved an initial IV loading dose of phenobarbital 5–8 mg/kg based on ideal body weight (IBW), or adjusted body weight if >130% IBW, administered as an infusion over 10–30 minutes in 100 mL normal saline. Additional doses of phenobarbital 65–130 mg IV push were given at physician discretion based on withdrawal symptoms.

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