Misc Phenobarbital ideal for treatment of severe alcohol withdrawal

[Conky]

For all you pharmacology nerds

tldr

Pulmcrit- Evidence Update: Phenobarbital in Alcohol Withdrawal

Over the past year, the five papers below were published regarding the use of phenobarbital in alcohol withdrawal. These studies aren’t massive, glittering multicenter RCTs (and, realistically, it’s dubious whether such a study will happen). However, these papers bring some unique and...

emcrit.org

https://www.heighpubs.org/jcicm/pdf/jcicm-aid1023.pdf

Seems promising. I like how it has much stronger & direct anti glutamate activity than any benzo. Phenobarb should be used to treat the zolam addicts and the drinkers that start their days with a full glass of vodka.

 

[JTemperance]

I'm sold on good old phenobarb— that's a great presentation (or poster or whatever). Do benzos possess any advantages over phenobarbital for inpatient alcohol detox?

 

[Jabberwocky]

benzos never hit that itch I still have when coming off booze

dose this work? I've never tried any barbiturates idk what they feel like

 

[Conky]

Do benzos possess any advantages over phenobarbital for inpatient alcohol detox?

Not really

Even the fast acting barbiturates are quite safe as long as no other depressants are involved

A therapeutic dose of secobarbital is like 100mg-300mg and for assisted suicide they give you like 15 grams to consume orally or 2 grams Thiopental IV

So yeah, the only advantage benzos have is physician familiarity

Phenobarbital is cheap, reliable, predictable, and seems to lead to shorter hospital stays and less need for additional agents to treat the withdrawal

260mg IV to terminate DTs vs repeated Lorazepam dosing+Haloperidol

benzos never hit that itch I still have when coming off booze

dose this work? I've never tried any barbiturates idk what they feel like

Yeah it works

Benzos simply act as positive modulators of GABA

Barbs do that too but they also antagonise glutamate which leads to a more 'complete' depression of the nervous system and the possibility of fatal overdoses which are actually rare without alcohol or opiates getting involved

Also at high doses they act directly as GABA agonists