Phenobarbital and diazepam performed alike for inpatient alcohol withdrawal in nearly 25,000 admissions

The edition in brief

A JAMA Internal Medicine study, published on 12 October, emulated a trial of phenobarbital against diazepam started on the day of admission for alcohol withdrawal, using records of 24,643 patients from 754 US hospitals. Length of stay (4.1 against 4.3 days) and invasive ventilation (3.1% against 2.7%) did not differ; self-directed discharge was less frequent with phenobarbital. The practical reading is that either drug is reasonable, chosen by local protocol and monitoring capacity. A systematic review of 90 trials for the American College of Physicians found oestrogen, with or without a progestogen, reduced both frequency and severity of menopausal vasomotor symptoms and was of high economic value; neurokinin receptor antagonists, SSRIs, SNRIs and gabapentin cut frequency but not severity, and fezolinetant was judged low value. Long-term harm data were limited. A JGIM interrupted time series of 3,246 community-dwelling older adults with dementia found opioid prescribing fell over 2010 to 2022 independent of the 2016 CDC guideline, tramadol fell after it, and gabapentinoid prescribing rose from 9.5% to 11.5%. The pearl covers thiamine in alcohol withdrawal.