• Yoonsun Mo, Michael C Thomas, and George E Karras.
• Department of Pharmacy Practice, Western New England University College of Pharmacy, 1215 Wilbraham Road, Springfield, MA 01119; Mercy Medical Center, 271 Carew Street, Springfield, MA 01104. Electronic address: yoonsun.mo@wne.edu.
• J Crit Care. 2016 Apr 1; 32: 101-7.

PurposeTo perform a systematic review of the clinical trials concerning the use of barbiturates for the treatment of acute alcohol withdrawal syndrome (AWS).Materials And MethodsA literature search of MEDLINE, EMBASE, and the Cochrane Library, together with a manual citation review was conducted. We selected English-language clinical trials (controlled and observational studies) evaluating the efficacy and safety of barbiturates compared with benzodiazepine (BZD) therapy for the treatment of AWS in the acute care setting. Data extracted from the included trials were duration of delirium, number of seizures, length of intensive care unit and hospital stay, cumulated doses of barbiturates and BZDs, and respiratory or cardiac complications.ResultsSeven studies consisting of 4 prospective controlled and 3 retrospective trials were identified. Results from all the included studies suggest that barbiturates alone or in combination with BZDs are at least as effective as BZDs in the treatment of AWS. Furthermore, barbiturates appear to have acceptable tolerability and safety profiles, which were similar to those of BZDs in patients with AWS.ConclusionsAlthough the evidence is limited, based on our findings, adding phenobarbital to a BZD-based regimen is a reasonable option, particularly in patients with BZD-refractory AWS.Copyright © 2015 Elsevier Inc. All rights reserved.

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