Use of Phenobarbital in Delirium Tremens

The standard of care for alcohol withdrawal centers on the use of escalating doses of benzodiazepines until clinical improvement is achieved. However, there is no established standard in the care of patients with severe alcohol withdrawal and delirium tremens that is refractory to benzodiazepine therapy. One potential therapy that is gaining traction is the use of phenobarbital, which may be mechanistically superior to benzodiazepines in treating delirium tremens because of its effects on GABA and N-methyl-D-aspartate receptors. The dosing of phenobarbital and its subsequent taper, however, is still unclear and the side effect profile is not well characterized. In this case report, we present the case of a 37-year-old Hispanic male who presented with alcohol withdrawal and subsequent delirium tremens who was treated with phenobarbital with positive clinical response and minimal side effects.