Ingebrigtson Megan, Schang Sarah, Hyzy Robert C, McSparron Jakob I, Chen Xi, Tapper Elliot B, Kenes Michael T
Department of Pharmacy, Michigan Medicine, Department of Clinical Pharmacy, College of Pharmacy, Ann Arbor, MI, USA.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
J Pharm Pract. 2025 Apr;38(2):231-236. doi: 10.1177/08971900241273144. Epub 2024 Sep 11.
Phenobarbital (PHB) is a safe and efficacious alternative to benzodiazepines (BZD) for treating severe alcohol withdrawal (AWS). However, the safety of utilizing PHB for patients initially treated with BZD is unknown. To evaluate the safety and efficacy of PBH compared to BZDs in severe AWS in the medical intensive care unit (ICU). This was a retrospective cohort study comparing critically ill patients admitted for AWS who received BZDs or PHB. The primary outcome was time to persistent resolution of altered mentation. Secondary outcomes included development and duration of delirium, need for mechanical ventilation, development of withdrawal seizures, and ICU and hospital length of stay. Ninety-five patients were evaluated (53 in PHB group, 42 in BZD group). Before study medication, less BZD patients demonstrated abnormal mentation compared with PHB patients (RASS < -2: 2.39% vsvs. 28.12%, respectively, and RASS > +2: 9.9% vsvs. 48.76%; <0.001 for both). No difference was seen between groups for the primary outcome (1.8 hours for BZD cohort vsvs. 13.81 hours for PHB cohort; =0.22). More patients in the BZD cohort developed a seizure after study medication administration (5.67% vs 0%, respectively; =0.02). No significant difference was seen in other secondary outcomes. This study provides support for use of PHB after BZD if patients remain in uncontrolled withdrawal. Despite significant doses of BZDs before PHB, patients in the PHB cohort demonstrated similar clinical and safety outcomes compared to BZD alone.
苯巴比妥（PHB）是治疗严重酒精戒断（AWS）时替代苯二氮䓬类药物（BZD）的一种安全有效的药物。然而，对于最初接受BZD治疗的患者使用PHB的安全性尚不清楚。为了评估在医学重症监护病房（ICU）中，与BZD相比，PHB治疗严重AWS的安全性和有效性。这是一项回顾性队列研究，比较因AWS入院并接受BZD或PHB治疗的重症患者。主要结局是精神状态改变持续缓解的时间。次要结局包括谵妄的发生和持续时间、机械通气需求、戒断性癫痫发作的发生以及ICU和住院时间。共评估了95例患者（PHB组53例，BZD组42例）。在使用研究药物前，与PHB组患者相比，BZD组患者出现精神状态异常的比例更低（RASS＜-2：分别为2.39%对28.12%，RASS＞+2：9.9%对48.76%；两者均P＜0.001）。两组在主要结局方面无差异（BZD队列1.8小时对PHB队列13.81小时；P =0.22）。BZD队列中更多患者在使用研究药物后发生癫痫发作（分别为5.67%对0%；P =0.02）。在其他次要结局方面未观察到显著差异。本研究支持在患者戒断状态未得到控制时，在BZD治疗后使用PHB。尽管在使用PHB前使用了大剂量的BZD，但与单独使用BZD相比，PHB队列中的患者具有相似的临床和安全结局。
