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Cited by 51Alcoholism and Thiamine DeficiencyAnesthesia and Sedative AgentsSubstance Abuse Treatment and Outcomes

Propofol for Treatment of Refractory Alcohol Withdrawal Syndrome: A Review of the Literature

Brotherton, Amy L., Hamilton, Eric P., Kloss, H. Grace, Hammond, Drayton A.·2016·Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
DOI 10.1002/phar.1726
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Abstract

The authors evaluated all available evidence on the use of propofol as an adjuvant for the treatment of resistant alcohol withdrawal syndrome (AWS) in comparison to other therapies. A comprehensive PubMed search (1966-December 2015) was conducted using the search terms propofol, alcohol withdrawal, and drug therapy. Articles were cross-referenced for other citations. Clinical studies, case series, and case reports published in the English language assessing the use of propofol in adult patients for treatment of AWS were reviewed for inclusion. Propofol is a sedative-hypnotic that exerts its actions through agonism of GABAA receptors at a different binding site than benzodiazepines and reduces glutamatergic activity through N-methyl-d-aspartase (NMDA) receptor blockade. Dosages from 5 to 100 μg/kg/minute reduced AWS symptoms with frequent development of hypotension and requirement for mechanical ventilation. Patients on propofol often experienced longer durations of mechanical ventilation and length of stay, which may be attributed to more-resistant cases of AWS. When propofol was compared with dexmedetomidine as adjuncts in AWS, both agents showed similar benzodiazepine- and haloperidol-sparing effects. Dexmedetomidine was associated with more numerical rates of bradycardia, while propofol was associated with more numerical instances of hypotension. Dexmedetomidine was used more frequently in nonintubated patients. The available data assessing the utility of propofol for AWS exhibited significant heterogeneity. Propofol may be useful in a specific population of patients with AWS, limited to those who are not clinically responding to first-line therapy with benzodiazepines. Specifically, propofol should be considered in patients who are refractory to or not candidates for other adjuvant therapies, patients already requiring mechanical ventilation, or those with seizure activity or refractory delirium tremens. In severe, refractory AWS, adjuvant therapy with propofol may be considered but requires further research to recommend its use either preferentially or as monotherapy.

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Crossref · 10.1002/phar.1726

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  • Propofol use is often associated with frequent development of hypotension and the need for mechanical ventilation.

    “Dosages from 5.0 to 100.0 μg/kg/min have demonstrated effectiveness in reducing AWS symptoms, but its use is often associated with the frequent development of hypotension and the need for mechanical ventilation.”

    From A Narrative Review of Current and Emerging Trends in the Treatment of Alcohol Use Disorder (2024) · cites this paper as [26]

  • A comprehensive review concluded that propofol for AWS yields mixed results, with propofol comparable to benzodiazepine monotherapy for severe alcohol withdrawal.

    “A comprehensive review [26] concluded that propofol for AWS yields mixed results, with propofol being comparable to benzodiazepine monotherapy for severe alcohol withdrawal.”

    From A Narrative Review of Current and Emerging Trends in the Treatment of Alcohol Use Disorder (2024) · cites this paper as [26]

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Authors
Brotherton, A. L., Hamilton, E. P., Kloss, H. G., & Hammond, D. A.
Affiliations
  • University of Arkansas Medical Center (US)
  • University of Arkansas for Medical Sciences (US)
Corresponding author
Hammond, Drayton A.
ORCID
Venue
Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
Publisher
Wiley
Published
2016-04
Volume
36
Issue
4
Pages
433-442
ISSN
  • 0277-0008 (ISSN-L)
  • 1875-9114
DOI
10.1002/phar.1726
OpenAlex
W2283588324
Cited by
51
References
52
Citations by year
2026: 3 · 2025: 1 · 2024: 7 · 2023: 7 · 2022: 5 · 2021: 5 · 2020: 10 · 2019: 5 · 2018: 3 · 2017: 4 · 2016: 1
FWCI
3.26
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Neurology › Alcoholism and Thiamine Deficiency
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
propofol, alcohol withdrawal, adjuvant therapy, dexmedetomidine, NMDA receptor blockade, hypotension, mechanical ventilation, delirium tremens, sedative-hypnotic drugs
MeSH terms
Adult, Bradycardia, Dose-Response Relationship, Drug, Drug Resistance, Humans, Hypnotics and Sedatives, Hypotension, Length of Stay, Respiration, Artificial, Severity of Illness Index, Propofol, Chemotherapy, Adjuvant, Practice Guidelines as Topic, Evidence-Based Medicine, Alcohol-Induced Disorders, Nervous System, Dexmedetomidine, Precision Medicine, Adrenergic alpha-2 Receptor Agonists, GABA-A Receptor Agonists

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