When to use phenobarbital over lorazepam or chlordiazepoxide for alcohol withdrawal

Phenobarbital is being increasingly used on the wards for alcohol withdrawal because it’s safe, effective, and cheap. Consider using it when the CIWA score is >15, pt is going through rapid withdrawal, or is at a point when you would normally consider IV benzos. Start with a bolus of 65-130 mg phenobarbital. Of note, phenobarbital must be tapered over the course of a week, so patients must be able to be compliant with a week-long regimen.


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