Alcohol Withdrawal Prophylaxis and Treatment

Original Date: 10/2025

Alcohol Withdrawal Prophylaxis and Treatment

  • For intubated patients on propofol or midazolam drips for sedation, no additional therapy is required.
  • If agitation and/or delirium persists after a total cumulative phenobarbital dose of 30 mg/kg, do not increase dosage and consider different diagnosis.
  • For breakthrough symptoms, give phenobarbital 100-200mg PO 6-8 hours to a target RASS of -1 to 0.
  • If a patient develops active delirium tremens after starting the phenobarbital taper, transition to the beginning of the “Alcohol Withdrawal ICU Admit” pathway.
  • Exclude: Those on essential medications or conditions that interact with phenobarbital. Advanced cirrhosis with hepatic encephalopathy (MELD >10), antiretroviral treatment, chronic use of phenobarbital.