Phenobarbital for Alcohol Withdrawal in the Emergency Department

During a national benzodiazepine shortage, phenobarbital reemerged as a treatment for alcohol withdrawal syndrome (AWS) and is now being used in many emergency departments (EDs), intensive care units, and even some inpatient floors, although supporting evidence for this practice remains limited.

In this single-center, retrospective study of 777 ED encounters (involving 549 patients), investigators compared three treatment options available in an ED AWS order set: intravenous (IV) benzodiazepines alone, IV phenobarbital alone, or a combination of both. Treatment choice was at the discretion of the ED clinician.