It has been said that alcoholics exist to teach physicians humility. These patients are quite complicated, often suffering from several problems simultaneously (e.g., withdrawal, nutritional deficiencies, trauma, infection, psychiatric problems). Arguably the most important task when treating alcohol withdrawal is exclusion of alternative or superimposed problems. Phenobarbital obviously cannot be expected to solve every problem that may exist in an alcoholic patient.
Phenobarbital does, however, appear to be a uniquely effective and safe treatment for alcohol withdrawal (including withdrawal seizures and delirium tremens). Several reasons for the superiority of phenobarbital are listed above. Preliminary evidence suggests that these do indeed translate into meaningful clinical benefit (e.g. faster recovery, fewer complications).
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