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Phenobarbital for alcohol withdrawal symptoms

Lin, Michelle MD

doi: 10.1097/01.EEM.0000824164.73418.8a

Figure:

alcohol withdrawal, phenobarbital, best practices

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Does your patient have more than a mild case of alcohol withdrawal symptoms? Consider giving IV phenobarbital as a first-line agent instead of a benzodiazepine. The initial dose is usually 130 to 260 mg.

What are the benefits of phenobarbital? So many of them are described perfectly in detail by Josh Farkas, MD. (EMCcrit.org. https://bit.ly/3r8dixb.) But here are some reasons.

  • Benzodiazepines can give patients paradoxical agitation and delirium.
  • The pharmacokinetics and pharmacodynamics of phenobarbital are much more predictable.
  • Given the long half-life of phenobarbital, it provides an automatic and gentle self-tapping effect over two to three days.

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Dr Linis the founder, CEO and editor of Academic Life in Emergency Medicine (https://www.ALiEM.com) and professor of emergency medicine at the University of California, San Francisco with interests in health professions education and digital scholarship. Follow her on Instagram@MichelleLinMDand on Twitter@M_Lin.

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