Delirium tremens and physical alcohol withdrawal: A double-blind comparison of phenobarbital and barbital treatment

Thirty-seven patients with delirium tremens or other signs of alcohol withdrawal were included in a double-blind randomized study of the effect of phenobarbital (19 patients) versus barbital (18 patients). Since 1909 barbital has been considered the preferred drug for treatment of alcohol withdrawal in Denmark. The patients were treated with tablets of phenobarbital, 100 mg, or barbital, 250 mg, to terminate symptoms of the withdrawal reaction and induce sleep. The groups were comparable as to age, sex distribution, severity of disease, and anamnestic information about drinking habits. The course of treatment was monitored by the Delirum Tremens Rating Scale and by the following outcome measures: medication to sleep, hours to sleep, total medication doses, and hours to last dose. There were no statistically significant differences between phenobarbital- and barbital-treated patients in any of the measures applied. Sleep was induced within a few hours in both groups, and there were no adverse effects of the treatment in any patient. There were no signs of induction of hepatic microsomal metabolism as evaluated by means of the antipyrine clearance, and there were no statistically significant differences between treatment groups in plasma levels of aspartate aminotransferase or coagulation factors II + VII + X. The two treatment regimens thus seemed equally effective. We recommend phenobarbital because 1) it is more widely known in clinical medicine and 2) it may be administered both intravenously and orally, whereas barbital can only be administered orally. Alcohol withdrawal, Antipyrine clearance, Barbital, Delirium tremens, Liver function, Phenobarbital.