JAMA Netw Open

Phenobarbital protocol cuts alcohol withdrawal treatment time, hospital length of stay

October 8, 2025

Hospital-wide adoption of a weight-based phenobarbital protocol for alcohol withdrawal syndrome (AWS) led to more rapid symptom control and shorter hospital stays, without increased safety risks. These findings support broader use of phenobarbital-based AWS treatment in diverse inpatient settings.

Study details: This retrospective quality improvement study evaluated the implementation of an electronic health record order set for IV, weight-based phenobarbital loading (10 or 15 mg/kg) across all care locations (ED, acute care, ICU) in a 281-bed community hospital. Adults treated for alcohol withdrawal syndrome (AWS) were compared 11 months before and 12 months after protocol implementation (N = 254; mean age, 53 years; 67% male).

Results: After implementation, the phenobarbital order set was used in 67% of post-implementation patients, mainly outside the ICU. Phenobarbital use was associated with faster symptom resolution (4.2–5.0 point reduction in daily maximum CIWA-Ar scores at 24–96 hours), a 30-hour reduction in AWS treatment duration, and a 2.2-day shorter time to hospital discharge. Safety outcomes—including prolonged restraint use, intubation, and in-hospital mortality—didn't differ significantly between groups.

Source:

Wolpaw BJ, et al. (2025, August 1). JAMA Netw Open. Hospital-Wide Implementation, Clinical Outcomes, and Safety of Phenobarbital for Alcohol Withdrawal. https://pubmed.ncbi.nlm.nih.gov/40853658/