The Use of Antiepileptic Drugs in Acute Neuropsychiatric Conditions: Focus on Traumatic Brain Injury, Pain, and Alcohol Withdrawal

Nejad, Shamim H.; Chuang, Kathy; Hirschberg, Ronald E.; Aquino, Patrick; Fricchione, Gregory L.

doi:10.4236/ijcm.2014.512099

Cited by 7 publications

(2 citation statements)

References 87 publications

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“…Phenobarbital is a promising therapeutic option for management of AWS because of its potentiating activity on GABA receptors and its antagonizing activity on NMDA (N-methyl-D-aspartate) and AMPA ( -amino-3-hydroxy-5-methyl-4-isoxazole propionic acid) receptors. 7,8 This mechanism of action differs from that of benzodiazepines, which act solely to potentiate GABA without affecting the increased activity of glutamate on neuronal receptors. The long half-life of phenobarbital eases the burden of administration compared with benzodiazepines, which may need to be given more than once per hour.…”

mentioning

confidence: 99%

Treatment of Alcohol Withdrawal Syndrome: Phenobarbital vs CIWA-Ar Protocol

Tidwell¹,

Thomas²,

Pouliot³

et al. 2018

Am J Crit Care

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Background Benzodiazepine-based therapy for alcohol withdrawal is associated with agitation and respiratory depression. Treatment can be complicated by a need for adjunctive therapy to control these symptoms and in patients requiring mechanical ventilation. Strong evidence for the effectiveness of alternative treatment modalities is lacking, despite the availability of promising pharmacological agents such as phenobarbital. Objective To compare the standard of care for the treatment of alcohol withdrawal-a symptom-triggered benzodiazepine protocol used in conjunction with the revised Clinical Institute Withdrawal Assessment of Alcohol (CIWA-Ar) scale-with a phenobarbital protocol. Methods Retrospective cohort study conducted from January 2016 through June 2017 at a 42-bed medical intensive care unit in a private teaching hospital in Nashville, Tennessee. The primary outcome was intensive care unit length of stay. Secondary outcomes included hospital length of stay, incidence of invasive mechanical ventilation, and use of adjunctive pharmacotherapy. Results Patients who received phenobarbital had significantly shorter stays in the intensive care unit than did those who received therapy based on the CIWA-Ar scale (mean [SD], 2.4 [1.5] vs 4.4 [3.9] days; P < .001). Those who received phenobarbital also had significantly shorter hospital stays (4.3 [3.4] vs 6.9 [6.6] days; P = .004). The incidence of invasive mechanical ventilation was lower in the phenobarbital group (1 [2%] vs 14 [23%] patients; P < .001), as was use of adjunctive agents for symptom control, including dexmedetomidine (4 [7%] vs 17 [28%] patients; P = .002). Conclusion A phenobarbital protocol for the treatment of alcohol withdrawal is an effective alternative to the standard-of-care protocol of symptom-triggered benzodiazepine therapy.

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mentioning

confidence: 99%

Treatment of Alcohol Withdrawal Syndrome: Phenobarbital vs CIWA-Ar Protocol

Tidwell¹,

Thomas²,

Pouliot³

et al. 2018

Am J Crit Care

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show abstract

“…Phenobarbital is a barbiturate that, like benzodiazepines and alcohol, targets GABA receptors in the CNS. It is a promising drug for AWS because of its potentiating activity on GABA receptors and its antagonizing activity on N-methyl-D-aspartate (NMDA) and α-amino-3-hydroxy-5methyl-4-isoxazole propionic acid (AMPA) receptors [11,12]. Its mechanism of action differs from that of benzodiazepines which act solely to potentiate GABA without affecting the increased activity of glutamate on neuronal receptors.…”

Section: Advantages Of Phenobarbital Over Benzodiazepinesmentioning

confidence: 99%

Update on Phenobarbital for Alcohol Withdrawal Syndrome in Intensive Care

Parthvi¹,

Parker²

2019

J Clin Intensive Care Med

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Alcohol abuse is a global health problem. Alcohol withdrawal syndrome (AWS) ranges from mild to severe symptoms that can lead to fatal delirium tremens requiring ICU admission and incurring high health care cost as high as $20,000 a month. The latest published reports suggest that phenobarbital is a promising therapeutic option for management of AWS as evidenced by less ICU admissions, length of stay in hospital, use of adjunctive agents, health care costs and attention from the nursing staff than that of patients treated with commonly used benzodiazepines such as lorazepam, diazepam, and chlordiazepoxide. Phenobarbital is benefi cial for the treatment of AWS, both in the emergency and inpatient settings and both as monotherapy or in conjunction with benzodiazepines. It is safe for patients without severe hepatic impairment, has a better mechanism of action and longer half-life than benzodiazepines, and leads to less delirium and agitation. Powered randomized controlled trials with large populations are required, yet phenobarbital can be used to safely to treat AWS.

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Impact of Number of Drugs on Rehabilitation Outcomes in Patients after Traumatic Brain Injury: A Retrospective Cohort Study

Yamaoka

Chono

Fukumoto

et al. 2020

PM&R

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Objective To investigate the impact of the number of drugs on rehabilitation outcomes for patients with acute traumatic brain injury. Design Retrospective cohort study. Setting Hospital‐based database created by the Japan Medical Data Center. Participants Patients with acute traumatic brain injury admitted between April 2014 and November 2017. Methods Analysis of relationships among 1‐5 and ≥ 6 drugs as well as clinical outcomes in 2603 patients. Main Outcome Measurements The primary outcome was defined as the Barthel index efficiency, and the secondary outcome was Barthel index gain and length of hospital stay. Results Median Barthel index score on admission was 40. Barthel index efficiency and Barthel index gain were significantly higher in the group that had taken 1‐5 drugs than in the group that had taken ≥6 drugs on admission (median: 1.19 vs 0.50, 20.0 vs 10.0). Also, the group that had taken 1‐5 drugs had a significantly shorter length of hospital stay than in the group that had taken ≥6 drugs on admission (median 11.0 vs 14.0). Moreover, multiple linear regression analysis showed that having taken ≥6 drugs on admission was independently associated with Barthel index efficiency, Barthel index gain, and length of stay. Conclusions Taking≥6 drugs for acute traumatic brain injury was associated with lower Barthel index efficiency, lower Barthel index gain, and longer length of stay than taking 1‐5 drugs.

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The Use of Antiepileptic Drugs in Acute Neuropsychiatric Conditions: Focus on Traumatic Brain Injury, Pain, and Alcohol Withdrawal

Cited by 7 publications

References 87 publications

Treatment of Alcohol Withdrawal Syndrome: Phenobarbital vs CIWA-Ar Protocol

Treatment of Alcohol Withdrawal Syndrome: Phenobarbital vs CIWA-Ar Protocol

Update on Phenobarbital for Alcohol Withdrawal Syndrome in Intensive Care

Impact of Number of Drugs on Rehabilitation Outcomes in Patients after Traumatic Brain Injury: A Retrospective Cohort Study

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