2026 Critical Care Congress Skip to main content
2026 Critical Care Congress Main banner
Final Program


Advance Program
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Session Icons
Thought Leader Session
Thought Leader Session
Guidelines Session
Guidelines Session
Aging Adult Track
Aging Adult Track
Additional Registration Fee
Additional Registration Fee

Research Snapshot Theater: Behavioral Health and Well-Being, Adult

Comparison of Phenobarbital Fixed Loading Dose Versus Weight-Based Dosing for Alcohol Withdrawal

Sunday, March 22, 2026
11:00 AM - 12:00 PM Central Time
Location: Connections Central - RST 01
  • DS

    Diane Shin, PharmD (she/her/hers)

    Beth Israel Deaconess Medical Center, Massachusetts

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • XT

    Xia Thai, PharmD, BCPS

    Senior Clinical Pharmacist Specialist
    Cambridge Health Alliance, Massachusetts

    Disclosure information not submitted.

  • SY

    Shirley Yu, PharmD, BCPS

    Senior Clinical Pharmacist Specialist
    Cambridge Health Alliance, Massachusetts

    Disclosure information not submitted.

Introduction: Phenobarbital given as a 10 mg/kg loading dose based on ideal body weight has been consistently used in the literature as a standard dosing strategy for management of alcohol withdrawal. Operational challenges can result in institutions adopting a fixed dose to expedite time to administration. The objective of this study is to assess if the fixed phenobarbital loading dose strategy can shorten time to administration while maintaining efficacy and safety compared to the weight-based dosing strategy.


Methods: A retrospective, observational cohort study was conducted in two academic Emergency Departments located in Massachusetts. A list of patients was generated from the electronic medical record for all adult patients who were ordered for a phenobarbital loading dose between February 1, 2024 and February 28, 2025 and reviewed for study inclusion. Patients were excluded if they left against medical advice, transferred to another institution, or did not receive treatments in accordance with internal guidelines. Patients from September 2024 were excluded due to being a transitional period.


Results: A total of 180 patients were assessed for eligibility, 142 of whom were included in analysis. 78 patients received a weight-based loading dose, and 64 patients received a fixed loading dose. All patients in the phenobarbital fixed loading dose arm received a loading dose of 650 mg with no patients weighing ≤ 45 kgs. Baseline demographics were similar in both groups.

The fixed loading dose strategy significantly reduced phenobarbital administration time by approximately 50% (25.5 vs. 50 minutes, p < 0.001) without impact on safety, showing a decrease in the number of patients requiring ICU stay (22% vs. 45%), transfer from the medical floor to the ICU (3.1% vs. 6.4%), and requiring mechanical ventilation (1.6 vs. 7.7%). There were no clinically significant differences in adverse events between the two groups.


Conclusions: Utilization of a phenobarbital fixed loading dose may be considered safe, effective, and sustainable in patients presenting to the emergency department with alcohol withdrawal. However, further studies are needed to fully assess its impact on clinical outcomes.