Phenobarbital is a medication that doctors may prescribe to treat alcohol withdrawal syndrome (AWS) during detox. There are many risks associated with its use, and it’s typically only used in rehab facilities.

Alcohol withdrawal syndrome (AWS) can occur when you stop or limit alcohol use after a period of prolonged and heavy use. This syndrome happens because of alcohol-induced changes to the brain’s neurochemistry over time.

Symptoms are usually mild and may include mild anxiety, headaches, and insomnia. However, AWS can sometimes cause severe and potentially life threatening symptoms, such as delirium and seizures.

Phenobarbital helps reduce the severity of AWS symptoms and complications. That said, its use is limited to those with severe symptoms who are undergoing inpatient care.

We’ll outline alcohol use disorder (AUD) and its relation to AWS and describe how phenobarbital helps to treat AWS.

Phenobarbital belongs to a class of drugs called barbiturates. These drugs work by slowing activity in the brain.

Doctors may prescribe phenobarbital to treat AWS and reduce the risk of life threatening complications.

In order to understand how phenobarbital helps to treat AWS, it’s important to understand how long-term alcohol consumption affects the brain’s neurochemistry.

The brain produces two neurochemicals that work in harmony to balance the brain’s activity levels:

  • Gamma-aminobutyric acid (GABA): This neurochemical works on receptors called GABA receptors to slow brain activity and produce a calming effect.
  • Glutamate: This neurochemical works on glutamate receptors to increase brain activity and produce a stimulating effect.

Alcohol acts as a depressant, meaning that it decreases brain activity. If you engage in excessive, long-term alcohol consumption, your brain tries to counteract the depressant effect of the alcohol. It does this by reducing the number of GABA receptors and increasing the number of glutamate receptors.

If you have AUD and suddenly stop consuming alcohol, your brain receptors are not prepared for this change. The low number of GABA receptors and high number of glutamate receptors make your brain overly sensitive to stimulation.

Phenobarbital is a barbiturate medication that works on both GABA and glutamate receptors to help slow brain activity. Therefore, it reduces the severity of AWS symptoms.

Are seizures common during alcohol withdrawal?

Not typically. Seizures only occur in the most severe cases. These cases will also typically require at least some time in a recovery facility where you can be monitored for signs of seizures or other life threatening symptoms.

A 2023 research review lists seizures as a common complication of AWS, noting that alcohol withdrawal seizures typically occur between 8 and 48 hours after quitting alcohol. The review adds that these seizures can occur in the absence of other AWS signs and symptoms.

According to a 2022 systematic review, severe AWS symptoms, such as seizures and delirium, occurred in around 20% of people with AWS.

Moreover, people who experience alcohol withdrawal seizures are at increased risk of developing recurrent seizures.

One of the main uses of phenobarbital is to prevent seizures. If your doctor feels you may be at risk of seizures during your recovery, they may prescribe phenobarbital.

Phenobarbital is only used in situations that require partial or constant monitoring to ensure the safety of the person in recovery. It’s typically only used during the first part of detox procedures.

The severity of alcohol withdrawal is labeled in levels 1 through 4. Levels 1 and 2 are the least severe and typically do not require a stay at a recovery facility. Levels 3 and 4 involve more dangerous and require at least a part-time stay at an inpatient facility.

Phenobarbital has many risks for side effects and interference with other medications. It’s typically not used for long periods of time and only under the supervision of specialized healthcare professionals. Your recovery team will discuss the benefits and risks with you whether they feel it’s necessary for your long-term health.

During your recovery, your prescribed phenobarbital dose will gradually decrease over time to prevent phenobarbital withdrawal symptoms, such as anxiety, muscle twitches, and seizures.

Phenobarbital may cause side effects, such as:

In some cases, phenobarbital may cause serious side effects. Call a doctor immediately if you experience any of the following:

Consuming alcohol while taking phenobarbital can worsen the side effects of phenobarbital.

Phenobarbital withdrawal symptoms

Suddenly stopping phenobarbital can also cause withdrawal symptoms, such as:

Doctors will taper the phenobarbital dosage over time to reduce the risks of phenobarbital withdrawal.

With the right support and guidance, it’s possible to make a full recovery from AUD. The following resources can help:

  • Alcoholics Anonymous: This is a 12-step program offering information and encouragement for attaining long-term sobriety.
  • SMART Recovery: This is a support group for people recovering from AUD or other types of addiction. It offers a 4-step program for recovery, as well as face-to-face and online meetings and access to a 24/7 chat room.
  • Centerstone.org: This is an organization offering educational resources on AUD prevention and treatments. It also provides fact sheets and other tools that can help you recognize if you have alcohol dependency or addiction.
  • Women for Sobriety: This is an organization offering a 13-statement program to help women overcome AUD and other types of addiction. Members have access to meetings and support groups, an online forum, and other useful tools.

You can also talk with a doctor for information, local support centers, and advice on recovering from AUD. In some situations, you may find that an inpatient recovery center to be the best option to support your recovery.

Phenobarbital is a medication that doctors may prescribe to treat alcohol withdrawal syndrome (AWS). It can help reduce the severity of AWS symptoms while also reducing the risk of complications, such as delirium and seizures.

Excessive, long-term alcohol consumption causes changes in the brain. Specifically, it reduces the number of receptors for “calming” neurochemicals and increases the number of receptors for excitatory neurochemicals.

If you have AUD and suddenly stop drinking alcohol, these brain changes lead to a surge in excitatory brain activity. Phenobarbital works by decreasing this activity.

With the right support and guidance, it’s possible to make a full recovery from AUD. Recovery programs that can help include Alcoholics Anonymous, SMART Recovery, and more. You can also talk with a doctor for further information and advice on quitting alcohol.