Adjunctive Phenobarbital for Alcohol Withdrawal Syndrome: A Focused Literature Review

Objective: To review the literature describing the use of adjunctive phenobarbital in the treatment of severe alcohol withdrawal syndrome (AWS). Data Sources: PubMed and EMBASE were searched using the following terms: phenobarbital, adjunct, refractory or treatment resistant, severe or complicated, and alcohol withdrawal delirium or alcohol withdrawal seizures. Study Selection and Data Extraction: The search was limited to randomized controlled trials (RCTs) and cohort studies published in English. Data Synthesis: Seven studies were identified in the emergency department (ED; RCT, n = 1; cohort, n = 2), general medicine ward (cohort, n = 1), and intensive care unit (ICU; cohort, n = 3) settings. For all studies set in the ED and general medicine ward and for 1 ICU study, phenobarbital plus symptom-guided benzodiazepine therapy was compared to symptom-guided benzodiazepine monotherapy. The other 2 ICU studies examined adjunctive phenobarbital before and after implementation of a protocol, meaning patients in both arms could have received phenobarbital. Overall risk of bias across all studies was low to moderate. Relevance to Patient Care and Clinical Practice: The specific role of adjunctive phenobarbital in AWS is not clear because a majority of studies are retrospective cohorts with varying primary outcomes in different patient care settings. Conclusions: In the ED and general medicine ward, phenobarbital demonstrated benzodiazepine-sparing effects. In the ICU, when a protocol guides phenobarbital use, the need for mechanical ventilation may be reduced. Adjunctive phenobarbital was well tolerated. Because of study limitations, it is challenging to provide specific recommendations for adjunctive phenobarbital use in severe AWS.

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Pharmacogenetic evaluation of adverse events’ risk in patients with alcohol withdrawal syndrome taking bromdihydrochlorphenylbenzodiazepine: The role of CYP2C19 gene polymorphisms

World Journal of Personalized Medicine ◽

10.14341/wjpm9262 ◽

2017 ◽

Vol 1 (1) ◽

pp. 18-26 ◽

Cited By ~ 1

Author(s):

Dmitriy V. Ivashchenko ◽

Kristina A. Ryzhykova ◽

Zhannet A. Sozaeva ◽

Mikhail S. Zastrozhin ◽

Elena A. Grishina ◽

...

Keyword(s):

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Rating Scale ◽

Venous Blood ◽

General Medicine ◽

Alcohol Withdrawal Syndrome ◽

Cyp2c19 Gene ◽

Icd 10 ◽

Rating Scale Data

Introduction. Bromdihydrochlorphenylbenzodiazepine is the Russian original tranquilizer which widely using in psychiatry, narcology, neurology and general medicine. Particularly, that drug prescribing for patients with alcohol withdrawal syndrome (AWS). Isoenzyme CYP2C19 takes part in metabolism of the most of benzodiazepines, so the gene CYP2C19 might be included into pharmacogenetics study of bromdihydrochlorphenylbenzodiazepine. There was no study of CYP2C19 polymorphisms as biomarkers of bromdihydrochlorphenylbenzodiazepine’s safety. Methods. 102 male patients with non-comlicated AWS (F 10.3 by ICD-10) were involved into the study. During 6 days of dynamic observation each participant was prescribed bromdihydrochlorphenylbenzodiazepine (Phenazepam). 5 ml of venous blood was collected from each participant for genotyping. 38 participants were added Pagluferal (contains phenobarbitalum, natrium coffeine-benzoate, bromisoval, papaverine) and/or Carbamazepine. Blood samples were analyzed to detect the CYP2C19*2 (rs4244285), *3 (rs4986893) и *17 (rs12248560) polymorphisms. Safety of therapy was evaluated with UKU Side Effects Rating Scale. Data analysis was performed with SPSS Statistics 21.0. Results. Carriers of CYP2C19*2 GA+AA genotypes compared to GG homozygous significantly more often had such adverse effects as «Polyuria/polydipsia» in mean grade of penetration (33,3% vs 9%, p=0,016) and “Palpitations/Tachycardia” (16,7% vs 3,8%, p=0,018). Observed relationship between «Polyuria/polydipsia» and CYP2C19*2 GA+AA genotypes was confirmed in the subgroup “Combined pharmacotherapy” (37,5% vs 0%, p=0,006). CYP2C19*17 polymorphism in tendency to significance was associated with less frequent AE «Polyuria/polydipsia» among patients taking bromdihydrochlorphenylbenzodiazepine as monotherapy carriers of allele T had that AE in 16,9%, and CC homozygous in 24,2% (p=0,067). Conclusion. Significant associations between CYP2C19*2 polymorphism and several AE in patients with alcohol withdrawal syndrome taking bromdihydrochlorphenylbenzodiazepine. Substantial role of CYP2C19*17 as predictor of AE associated with bromdihydrochlorphenylbenzodiazepine was not confirmed. Gene CYP2C19 is the sufficient biomarker of bromdihydrochlorphenylbenzodiazepine’s safety profile and needs further research.

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The Role of Barbiturates for Alcohol Withdrawal Syndrome

Psychosomatics ◽

10.1016/j.psym.2016.02.011 ◽

2016 ◽

Vol 57 (4) ◽

pp. 341-347 ◽

Cited By ~ 10

Author(s):

Katherine Martin ◽

Andrew Katz

Keyword(s):

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Alcohol Withdrawal Syndrome

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A Symptom-Triggered Benzodiazepine Protocol Utilizing SAS and CIWA-Ar Scoring for the Treatment of Alcohol Withdrawal Syndrome in the Critically Ill

Annals of Pharmacotherapy ◽

10.1177/1060028016672036 ◽

2016 ◽

Vol 51 (2) ◽

pp. 101-110 ◽

Cited By ~ 6

Author(s):

Soumitra Sen ◽

Philip Grgurich ◽

Amanda Tulolo ◽

Andrew Smith-Freedman ◽

Yuxiu Lei ◽

...

Keyword(s):

Mechanical Ventilation ◽

Critically Ill ◽

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Alcohol Withdrawal Syndrome ◽

Limited Data ◽

Safety And Efficacy ◽

Icu Length Of Stay ◽

Before And After ◽

Before And After Study

Background: There are limited data on the efficacy of symptom-triggered therapy for alcohol withdrawal syndrome (AWS) in the intensive care unit (ICU). Objective: To evaluate the safety and efficacy of a symptom-triggered benzodiazepine protocol utilizing Riker Sedation Agitation Scale (SAS) scoring for the treatment of AWS in the ICU. Methods: We performed a before-and-after study in a medical ICU. A protocol incorporating SAS scoring and symptom-triggered benzodiazepine dosing was implemented in place of a protocol that utilized the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale and fixed benzodiazepine dosing. Results: We enrolled 167 patients (135 in the preintervention and 32 in the postintervention group). The median duration of AWS was shorter in the postintervention (5, interquartile range [IQR] = 4-8 days) than in the preintervention group (8, IQR = 5-12 days; P < 0.01). Need for mechanical ventilation (31% vs 57%, P = 0.01), median ICU length of stay (LOS; 4, IQR = 2-7, vs 7, IQR = 4-11 days, P = 0.02), and hospital LOS (9, IQR = 6-13, vs 13, IQR = 9-18 days; P = 0.01) were less in the postintervention group. There was a reduction in mean total benzodiazepine exposure (74 ± 159 vs 450 ± 701 mg lorazepam; P < 0.01) in the postintervention group. Conclusion: A symptom-triggered benzodiazepine protocol utilizing SAS in critically ill patients is associated with a reduction in the duration of AWS treatment, benzodiazepine exposure, need for mechanical ventilation, and ICU and hospital LOS compared with a CIWA-Ar–based protocol using fixed benzodiazepine dosing.

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Role of Adenosine A1 and A2A Receptors in the Alcohol Withdrawal Syndrome

Alcohol ◽

10.1016/s0741-8329(99)00033-6 ◽

1999 ◽

Vol 19 (2) ◽

pp. 157-162 ◽

Cited By ~ 35

Author(s):

Gary B Kaplan ◽

Nazleen H Bharmal ◽

Kimberly A Leite-Morris ◽

Walter R Adams

Keyword(s):

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Alcohol Withdrawal Syndrome ◽

A2a Receptors ◽

Adenosine A1

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Lorazepam versus chlordiazepoxide for the treatment of alcohol withdrawal syndrome and prevention of delirium tremens in general medicine ward patients

Alcohol ◽

10.1016/j.alcohol.2019.05.008 ◽

2019 ◽

Vol 81 ◽

pp. 56-60

Author(s):

Katherine L. March ◽

Jennifer D. Twilla ◽

Anne B. Reaves ◽

Timothy H. Self ◽

Melissa M. Slayton ◽

...

Keyword(s):

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Delirium Tremens ◽

General Medicine ◽

Alcohol Withdrawal Syndrome

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Role of MSCT in Diagnosis of Interstitial Lung Disease in Children

QJM ◽

10.1093/qjmed/hcaa068.002a ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

K A Ahmad ◽

L A Hegazy ◽

M A Nasr ◽

A A A Matar

Keyword(s):

Interstitial Lung Disease ◽

Lung Disease ◽

Data Extraction ◽

Systemic Disease ◽

Imaging Study ◽

Eligibility Criteria ◽

Data Synthesis ◽

Study Selection ◽

Ethical Approval

Abstract Introduction Children interstitial lung dieses (CHILD) is a heterogeneous group of disorders that overlap with ILD seen in adults, some are primary lung disorders while others are associated with systemic disease processes. Objectives This review aims to role of MSCT in Diagnosis of Interstitial Lung Disease in Children. Data Sources Medline databases (PubMed, Medscape, Science Direct. EMF-Portal) and all materials available in the Internet till 2018. Study Selection This search presented 55 articles. The articles studied the Role of MSCT in Diagnosis of Interstitial Lung Disease in Children. Data Extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Data Synthesis Comparisons were made by structured review with the results tabulated. Conclusions MSCT continues to be the preferred imaging study for the initial evaluation of suspected child.

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Evaluating the Use of Phenobarbital for the Management of Alcohol Withdrawal Syndrome in Psychiatric Inpatients

Journal of Pharmacy Practice ◽

10.1177/0897190018822561 ◽

2019 ◽

Vol 33 (4) ◽

pp. 477-480

Author(s):

Erin Waldee ◽

Stephanie V. Phan

Keyword(s):

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Vital Signs ◽

Alcohol Withdrawal Syndrome ◽

Psychiatric Inpatients ◽

Signs And Symptoms ◽

Altered Mental Status ◽

Treatment And Prevention ◽

Appropriate Therapy

Objectives To describe the potential role of phenobarbital as appropriate therapy in the treatment and prevention of alcohol withdrawal syndrome (AWS) among medically cleared psychiatric inpatients. Methods This was a single-center, retrospective, observational study of adult patients admitted to the psychiatric unit and administered phenobarbital for the treatment or prevention of AWS. Changes in vital signs and signs and symptoms of AWS were observed to assess the safety and efficacy of phenobarbital. The primary outcome was safety of phenobarbital for AWS as measured by change in the respiratory rate (RR). Results A total of 122 patients were included in the study. There were no significant changes in RR among patients who received phenobarbital for AWS. Significant reductions in blood pressure and heart rate were observed. Of patients with documented signs and symptoms of AWS upon admission, 94% had improvement in the signs and symptoms during phenobarbital therapy. Approximately 12% of patients had documented sedation or altered mental status during phenobarbital therapy. No patients required transfer to a medical or critical care unit. Conclusions Phenobarbital was safe, not leading to severe adverse effects or requiring a higher level of care, and efficacious for the prevention and treatment of AWS in this cohort of psychiatric inpatients.

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The New Macrolide Antibiotics: Azithromycin, Clarithromycin, Dirithromycin, and Roxithromycin

Annals of Pharmacotherapy ◽

10.1177/106002809202600112 ◽

1992 ◽

Vol 26 (1) ◽

pp. 46-55 ◽

Cited By ~ 90

Author(s):

Neeta Bahal ◽

Milap C. Nahata

Keyword(s):

Clinical Trials ◽

English Language ◽

Data Extraction ◽

Macrolide Antibiotics ◽

Data Synthesis ◽

Antimicrobial Spectrum ◽

Study Selection ◽

Frequent Administration ◽

Elimination Half

OBJECTIVE: To review the chemistry, antimicrobial spectrum, pharmacokinetics, clinical trials, adverse effects, and drug interactions of four new macrolide antibiotics: Azithromycin, clarithromycin, dirithromycin, and roxithromycin. DATA SOURCES: Information was obtained from comparative clinical trials, abstracts, conference proceedings, and review articles. Indexing terms included azithromycin, clarithromycin, dirithromycin, erythromycin, roxithromycin, and macrolide antibiotics. STUDY SELECTION: Emphasis was placed on comparative clinical trials involving the new macrolide antibiotics. DATA EXTRACTION: Data from human studies published in the English language were evaluated. Trials were assessed by sample size, macrolide dosage regimen, and therapeutic response. DATA SYNTHESIS: The erythromycins have gained widespread use in treating a variety of infections. Although they are effective, limitations include the need to administer four times a day and the intolerable adverse gastrointestinal effects. Four of the more extensively studied agents, azithromycin, clarithromycin, dirithromycin, and roxithromycin, are currently being studied in patients. Based on the studies to date, the newer macrolides may offer several advantages over erythromycin, including: (1) greater antimicrobial activity against certain organisms; (2) longer elimination half-life, thus allowing less frequent administration; and (3) lower incidence of adverse gastrointestinal effects. CONCLUSIONS: The new macrolide antibiotics appear to offer an improvement over erythromycin. Definitive conclusions about the role of these drugs should await completion of ongoing clinical studies.

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