Benzodiazepines vs barbiturates for alcohol withdrawal – Analysis of 3 different treatment protocols
Summary:
Due to the recent drug shortage of IV benzodiazepines, alternative agents are being incorporated into treatment protocols for acute alcohol withdrawal management. The objective of this retrospective cohort study was to describe the effectiveness of three alcohol withdrawal protocols during three time periods utilizing benzodiazepines and barbiturates for the acute treatment of alcohol withdrawal in the emergency department. The protocols were developed to account for product availability, and the patients were treated according to the specific protocol that was implemented during three separate time periods. The study was conducted at Denver Health Medical Center, which contains 525 inpatient bed and is a Level 1 trauma.
- Diazepam IV only protocol (D) was conducted from April 2016 to January 2017
- Lorazepam IV and phenobarbital IV protocol (L+P) was conducted from June 2017 to July 2017
- Phenobarbital IV only protocol (P) was conducted from December 2017 to January 2018
Overall, 500 patients were treated with (D) protocol, 320 with (L+P), and 299 were treated with (P) protocol. A convenience sample of 100 patients was obtained from each group and included in the study analysis.
There was no difference found in the primary outcome of ICU admission when compared against all three groups, but statistically significant differences were found in admission rates and length of stay. Overall, due to recent benzodiazepine drug shortages and occasional instances of benzodiazepine-resistant withdrawal, phenobarbital is a safe and effective treatment alternative for alcohol withdrawal.
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