Use of intravenous phenytoin in alcohol withdrawal seizures
The use of phenytoin in the treatment of patients with alcohol withdrawal seizures in the emergency department or in an alcohol detoxification unit is controversial. Alldredge and associates performed a randomized, double-blind, placebo-controlled study to assess the efficacy of intravenous phenytoin in patients at high risk for alcohol withdrawal seizures.
A total of 90 patients who were admitted to an emergency department within six hours of an initial alcohol withdrawal seizure were randomly assigned to treatment with 1,000 mg of intravenous phenytoin or Placebo. Patients with a history of seizures unrelated to alcohol withdrawal were excluded from the study. The end point of the study was either a recurrent seizure or a 12-hour seizure-free period.
Six of the 45 patients who received phenytoin and six of the 45 patients who received placebo had at least one seizure during the 12 hours following infusion. Serum phenytoin levels were comparable in patients with and without subsequent seizures.
The authors believe that the risks of intravenous phenytoin therapy outweigh the potential benefits in the short-term treatment of patients with alcohol withdrawal seizures. (American Journal of Medicine, December 1989, vol. 87, p. 645.)
COPYRIGHT 1990 American Academy of Family Physicians
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