Phenobarbital versus diazepam for delirium tremens--a retrospective study

Delirium tremens (DT) is a severe and potentially fatal condition that may occur during withdrawal from chronic alcohol intoxication. The purpose of the present study was to compare the effects and the rates of complications of phenobarbital and diazepam treatment in DT.

Data were collected retrospectively from the medical files of patients who had received DT treatment (n = 194) at two psychiatric departments located in the general Copenhagen area in the 1998-2006 period. At one department, all patients were treated with phenobarbital (n = 53), while the treatment regimen at the other department was changed from phenobarbital (n = 53) to diazepam (n = 88) in 2002.

Length of DT and hospitalization, mortality and rate of pneumonia (26%) were not affected by treatment. A subpopulation (9%) in the diazepam group was resistant to treatment. Respiratory depression occurred in 4% of the phenobarbital and in 1% of the diazepam-treated patients. Wernicke's encephalopathy was established in 47% of the patients.

Phenobarbital is a safe alternative to diazepam in the treatment of DT.