Treatment of the barbiturate abstinence syndrome

Patients with the barbiturate abstinence syndrome require pharmacotherapy (and hospitalization) when there is a history of the ingestion of greater than 0.4 g of secobarbital or its equivalent for 90 or more days, or of 0.6 g for 30 or more days, or a previous history of barbiturate withdrawal seizures or delirium. The pharmacological management of withdrawal, which is rational, safe, efficacious and relatively simple, is described and recommended. This treatment relies on a phenobarbital loading-dose technique which is titrated to clinical end-points. The prolonged elimination of phenobarbital prevents the reappearance of withdrawal symptoms and, since repeated doses are not required, results in less manipulative drug-seeking behaviour.