IBCC Episode 45 ETOH Withdrawal

This podcast episode centers on the use of phenobarbital monotherapy for managing alcohol withdrawal, challenging the conventional reliance on benzodiazepines. Josh argues phenobarbital is superior due to its uniform efficacy, addressing both GABA deficiency and excessive glutamate activity, unlike benzos. He highlights its predictable pharmacokinetics, allowing precise dose titration and a wider therapeutic index, reducing intubation risks. The discussion covers contraindications like unclear diagnoses or advanced cirrhosis, and emphasizes recognizing non-alcohol-related delirium (NARD) after phenobarbital loading, requiring alternative treatments like haloperidol. Practical issues such as using the RAS scale for therapeutic targeting and preventing withdrawal with prophylactic phenobarbital doses are also addressed.