Alcohol Withdrawal Syndrome Treated With Adjunctive Phenobarbital or Ketamine

NCT ID: NCT03788889

Last Updated: 2019-09-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

WITHDRAWN

Clinical Phase

PHASE4

Study Classification

INTERVENTIONAL

Study Start Date

2019-04-12

Study Completion Date

2019-04-12

Brief Summary

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The goal of this study will aim to determine if adding phenobarbital or ketamine to a symptom-triggered benzodiazepine regimen decreases the rate of intensive care unit admissions during the treatment of alcohol withdrawal syndrome when compared to symptom-triggered benzodiazepine therapy alone.

Detailed Description

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The primary objective of this study is to compare phenobarbital and ketamine adjunctive therapies to lorazepam-based therapy in the treatment of acute alcohol withdrawal syndrome.

It is hypothesized that the use of an alternative agent, either phenobarbital or ketamine, when used as an adjunct to symptom-triggered lorazepam therapy will significantly reduce the rate of intensive care unit admissions and thereby reduce the total cost associated with hospital admission for treatment of alcohol withdrawal syndrome.

Enrolled patients will be admitted to Santa Barbara Cottage Hospital where they will be monitored with continuous pulse oximetry and cardiac telemetry. They will remain hospitalized while undergoing study-guided therapy in addition to supportive care for acute alcohol withdrawal syndrome. Patients will undergo standard of care therapy with lorazepam symptom-triggered therapy regardless of study participation.

Conditions

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Alcohol Withdrawal Syndrome

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

prospective, randomized control trial
Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Investigators
Each participant will be randomized according to a web-based randomization program employed by a research pharmacist once the Emergency Department provider deems the patient appropriate for inpatient treatment of alcohol withdrawal syndrome.

Each medication will be packaged by Santa Barbara Cottage Hospital pharmacy. In order to blind both the clinicians and the participants, the pharmacy will provide medication bags that are identical. Therefore, Emergency Department nursing staff and physicians will be unaware of which study drug is being provided to the patient. Normal saline will be used as a placebo to mimic study drugs (phenobarbital and ketamine). Pharmacy will remain unblinded and maintain records of which treatment assignment is prepared for each patient.

Treatment will be provided for the duration of the patient's hospitalization; therefore, treatment compliance will be documented in the electronic health record using the medication bag identifier.

Study Groups

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Lorazepam + Ketamine + Placebo A

Ketamine - infusion (0.15 - 0.4 mg/kg/hr) and placebo injections titrated by increases of 0.075 mg/kg/hr every 30 minutes for Clinical Institute Withdrawal Assessment for Alcohol (revised version) (CIWA-Ar) greater than or equal to 10 in addition to lorazepam symptom-triggered therapy

Ketamine dosing will be based on ideal body weight

Ketamine infusion will be discontinued once CIWA-Ar less than 10 for 4 hours

Group Type ACTIVE_COMPARATOR

Ketamine

Intervention Type DRUG

Ketamine infusion

Lorazepam

Intervention Type DRUG

Standard of Care

Placebo A

Intervention Type DRUG

Placebo injection

Lorazepam + Phenobarbital + Placebo B

Phenobarbital - IV push (260 mg loading followed by 130 mg q1 hour) with placebo infusion until CIWA-Ar less than 10 with a maximum daily dose of 10mg/kg in addition to lorazepam symptom-triggered dosing for recurrent symptoms (Gold 2007)

Maximum daily dose will be used in order to prevent over sedation as well as provide adequate storage in pharmacy monitored refrigerators for study drugs

Group Type ACTIVE_COMPARATOR

Phenobarbital

Intervention Type DRUG

Phenobarbital intravenous injection

Lorazepam

Intervention Type DRUG

Standard of Care

Placebo B

Intervention Type DRUG

Placebo infusion

Lorazepam + Placebo A + Placebo B

Lorazepam will be administered every 30 minutes as indicated based on CIWA-Ar protocol for Cottage Health in addition to placebo injections and placebo infusion

Group Type PLACEBO_COMPARATOR

Lorazepam

Intervention Type DRUG

Standard of Care

Placebo A

Intervention Type DRUG

Placebo injection

Placebo B

Intervention Type DRUG

Placebo infusion

Interventions

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Ketamine

Ketamine infusion

Intervention Type DRUG

Phenobarbital

Phenobarbital intravenous injection

Intervention Type DRUG

Lorazepam

Standard of Care

Intervention Type DRUG

Placebo A

Placebo injection

Intervention Type DRUG

Placebo B

Placebo infusion

Intervention Type DRUG

Other Intervention Names

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Ketalar Solfoton, Luminal Ativan Normal saline Normal saline

Eligibility Criteria

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Inclusion Criteria

* Primary admitting diagnosis of acute alcohol withdrawal syndrome based on International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10), code F10.3, F10.4.

Exclusion Criteria

* Significant comorbid medical illness requiring Intensive Care Unit admission;
* Pregnancy;
* Inability to obtain intravenous access;
* Child Pugh Class C; and
* Allergy to study medications (phenobarbital, ketamine, lorazepam).
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Santa Barbara Cottage Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Noah Stites-Hallet, MD

Role: PRINCIPAL_INVESTIGATOR

Santa Barbara Cottage Hospital

Other Identifiers

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18-94

Identifier Type: -

Identifier Source: org_study_id

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