Efficacy and Safety of Lorazepam Versus Phenobarbital in Alcohol Withdrawal: A Retrospective Cohort Study

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Alcohol use disorder contributes significantly to morbidity and mortality, accounting for 6% of global deaths. American Society of Addiction Medicine guidelines recommend benzodiazepines as first‑line therapy for alcohol withdrawal syndrome (AWS), with phenobarbital or dexmedetomidine reserved for severe cases. Benzodiazepines may cause delirium, paradoxical agitation, and respiratory depression, necessitating alternatives for refractory AWS. Phenobarbital provides rapid IV onset and an auto‑tapering effect due to its long half‑life but carries risk for respiratory depression, limiting use on non-intensive care units. Recent studies demonstrate that phenobarbital is as safe and effective as benzodiazepines, reducing length of stay and adjunctive medication needs. This study evaluates phenobarbital's efficacy and safety versus lorazepam for AWS across care settings.

This retrospective, non‑inferiority study was deemed exempt from institutional review board oversight. It includes adults admitted to Corewell Health Grand Rapids Hospitals between May 1, 2024 and October 17, 2025, for alcohol withdrawal syndrome requiring lorazepam or phenobarbital. Exclusions include benzodiazepine use disorder, chronic benzodiazepine use, use of these agents for other indications, mechanical ventilation before study drug administration, repeat admissions, and presentation to outside emergency departments. The primary outcome is withdrawal treatment duration from first to last study medication dose. Secondary outcomes include safety (e.g., respiratory depression) and efficacy (therapy escalation, hospital and ICU length of stay, and withdrawal seizures). A sample size of 200 patients provides 80% power for non‑inferiority using a two‑sided alpha of 0.05 and a 12‑hour margin.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1959

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