Scientific Poster Session IV: Late-Breaking Original Research

Late Breaking Original Research
  Tuesday, November 14, 2023
  08:30 AM–10:00 AM

Abstract

Introduction: Phenobarbital has been demonstrated as a safe and effective alternative to benzodiazepines for alcohol withdrawal management. However, published data is lacking for the use of phenobarbital in patients admitted to the medical floor.

Research Question or Hypothesis: Is a phenobarbital fixed-dose protocol a safe and effective alternative to symptom-triggered benzodiazepines using a CIWA-Ar protocol in the management of alcohol withdrawal in medical floor patients?

Study Design: A retrospective chart review of patients admitted to the medical floor for acute alcohol withdrawal who received either a phenobarbital fixed-dose protocol or benzodiazepines with CIWA-Ar. Patients were excluded if they were younger than 18 years old or if they received both treatment modalities.

Methods: The primary outcome was to compare length of stay (LOS). Secondary outcomes included new delirium tremens (DTs), need for transfer to the intensive care unit (ICU) after initiation and other safety endpoints. Additional data collected: demographics, incidence of bradycardia, increased oxygen requirements and seizures. Data was analyzed using Statistical Package for the Social Sciences (SPSS) v28. An alpha of 0.05 was used and tests used included Fisher’s Exact or X2, Mann-Whitney U, and student’s t-test.

Results: The patient demographics between the phenobarbital (n=58) and CIWA-Ar (n=255) groups were similar. The median LOS (70 vs. 79 hours, p=0.165) and the rate of ICU transfer after therapy initiation (3.4% vs. 5.9%, p=0.748) was similar between the two groups. The phenobarbital group was associated with lower rates of new DTs after initiation (0% vs. 28.2%, p<0.0001). Other safety endpoints were similar except increased oxygen requirements, which was lower in the phenobarbital group (0% vs. 12%, p=0.0024).

Conclusion: A phenobarbital fixed-dose protocol is as effective as benzodiazepines with CIWA-Ar for alcohol withdrawal in patients admitted to the medical floor and may reduce the risk of adverse outcomes, including new DTs.

Presenting Author

Lindsay Saum PharmD, BCPS, BCGP
Butler University College of Pharmacy and Health Sciences & Ascension-St. Vincent Indianapolis

Authors

Vishal Ooka PharmD, BCCCP
Ascension-St. Vincent