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Using Phenobarbital in the Alcohol Detox Process

People who struggle with alcohol use disorder require medical supervision in order to withdraw from alcohol. Detoxing from alcohol can lead to serious withdrawal symptoms, including a condition called delirium tremens, which is characterized by fever, agitation, hallucinations, severe confusion, and seizures. Due to the potential for serious and even life-threatening withdrawal symptoms, medical detox is always required.

To prevent delirium tremens and other alcohol withdrawal symptoms, a medical professional will likely prescribe medications to help the person ease safely off their alcohol dependence. For the most part, benzodiazepines, especially diazepam (Valium), are prescribed in small, carefully monitored doses to ensure the person does not develop an addiction to the new medication. Benzodiazepines are very habit-forming. They can lead to intoxication and dependence when abused.

Medical professionals want to help their patients, so it is important to find ways to overcome alcohol use disorder without putting individuals at risk of another addiction. One of the suggestions, which is occasionally implemented in the United States, is to use phenobarbital instead of prescribing benzodiazepines.

What Is Phenobarbital?

Phenobarbital is a barbiturate, or sedative, medication that is typically used to control seizure disorders, such as epilepsy, and to relieve anxiety in some cases. According to the Epilepsy Foundation, it is the oldest medication used to treat seizures; phenobarbital was originally developed and released for medical use in 1912. It is on the World Health Organization’s List of Essential Medicines as of April 2015, but it has not been approved by the Food and Drug Administration for prescription use in the US. Instead, the drug is produced in different doses by several companies, including Aphena Pharma, Goldline Laboratories, Sterling Drug, and Smith Kline Consumer under a variety of brand names. The FDA allows some formulations of phenobarbital to be sold over the counter without a prescription.

Like many potent medications, phenobarbital can be habit-forming. While US regulations around the medication are complicated, it is important not to use this drug without the supervision of a medical professional and only upon their recommendation.

One of the other uses for phenobarbital is to moderate alcohol withdrawal symptoms. Since it is an anti-seizure medication, phenobarbital is particularly useful in preventing or moderating seizures related to delirium tremens; however, the drug is almost never prescribed for use in alcohol withdrawal since it is not as effective as benzodiazepines for some symptoms.
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How Is Phenobarbital Used in Alcohol Detox?

While long-acting benzodiazepines like Valium have long half-lives, phenobarbital can last even longer. The medication can last between 50 and 300 hours in the body, reducing the risk of seizures. Sedation from phenobarbital typically lasts 4-10 hours, but other effects of the drug may last longer.

For people overcoming alcohol use disorder, who are prone to seizures during withdrawal, phenobarbital may be a better solution than benzodiazepines. A study published in the Industrial Psychology Journal in 2013 found that “front-loading” phenobarbital via injection when a person is admitted to the hospital for alcohol use disorder was at least as effective as, and potentially more effective than, benzodiazepines for preventing delirium tremens seizures. Another study on PubMed found that, of 102 hospital patients overcoming alcohol use disorder, the 51 who received phenobarbital were less likely to be admitted to the ICU compared to the 51 who received lorazepam treatment.

Phenobarbital may be more effective when used once or twice during initial medically supervised detox rather than as a maintenance medication. Those who have relapsed into alcohol use disorder and repeatedly experienced delirium tremens may benefit from phenobarbital over benzodiazepines.

The drug also enhances the action of benzodiazepines. This is, in part, because both medications are central nervous system (CNS) depressants, and they both act on gamma-aminobutyric acid (GABA) receptors. In closely monitored settings, a doctor may combine a dose of phenobarbital with a routine dose of benzodiazepine in order to enhance the later effectiveness of the benzodiazepine. If a person has struggled with addiction to benzodiazepines as well as alcohol, then temporary use of phenobarbital could be more effective than trying to taper the benzodiazepine; otherwise, prescribing a benzodiazepine could trigger relapse.

How a Doctor Will Dose Phenobarbital

Doses of phenobarbital are described in terms of treating epilepsy or other seizure disorders, and the individual’s physician can adjust the dose depending on effectiveness. Phenobarbital is typically administered as a liquid injection. The recommended dose is 200 mg per mL. If the person has been prescribed a tablet or oral liquid, the dose is different; tablets range between 15 and 100 mg and can be adjusted depending on the severity of the individual’s condition. Liquid administered orally is about 15 mg per 5 mL and should be diluted before ingesting.

Doses could be higher or lower for those experiencing delirium tremens and alcohol withdrawal symptoms. A medical professional must routinely check in with their patient to ensure the person is not showing signs of phenobarbital addiction and that the medication is working as prescribed.

Overdose

It is possible to overdose on phenobarbital. Symptoms of overdose include:

  • Uncontrolled eye movements
  • Drowsiness, fatigue, or an inability to stay awake
  • Loss of coordination or stumbling as though drunk
  • Reduced or irregular breathing
  • Drop in body temperature
  • Blisters

Phenobarbital Side Effects

Phenobarbital can cause side effects. These are rarely serious and may include:

  • Drowsiness or fatigue
  • Headache
  • Dizziness
  • Increased excitement or physical energy, especially in children
  • Abdominal discomfort, nausea, or vomiting

If a person taking phenobarbital develops a fever, blistering skin, or intense confusion, they may be suffering serious side effects from the drug and should get immediate medical help.

Phenobarbital is more likely to depress respiration compared to benzodiazepines, and this could be a dangerous side effect. Respiratory depression and low blood pressure can lead to damage to organ systems, including the brain, due to lack of oxygen.

If a person wants to end their addiction to alcohol, it is important for them to get appropriate medical supervision. Delirium tremens can be a dangerous syndrome associated with alcohol use disorder and withdrawal, so managing this condition with medications is common. Although phenobarbital is not often applied to treat delirium tremens, it has been successfully prescribed in some cases, depending on the individual’s needs during detox.