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.
- 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.