-
Current Pediatric Reviews 2016Phenobarbital is an effective and safe anticonvulsant drug introduced in clinical use in 1904. Its mechanism of action is the synaptic inhibition through an action on... (Review)
Review
Phenobarbital is an effective and safe anticonvulsant drug introduced in clinical use in 1904. Its mechanism of action is the synaptic inhibition through an action on GABAA. The loading dose of phenobarbital is 20 mg/kg intravenously and the maintenance dose is 3 to 4 mg/kg by mouth. The serum concentration of phenobarbital is up to 40 µg/ml. Nonresponders should receive additional doses of 5 to 10 mg/kg until seizures stop. Infants with refractory seizures may have a serum concentration of phenobarbital of 100 µg/ml. Phenobarbital is metabolized in the liver by CYP2C9 with minor metabolism by CYP2C19 and CYP2E1. A quarter of the dose of phenobarbital is excreted unchanged in the urine. In adults, the half-life of phenobarbital is 100 hours and in term and preterm infants is 103 and 141 hours, respectively. The half-life of phenobarbital decreases 4.6 hours per day and it is 67 hours in infants 4 week old.
Topics: Anticonvulsants; Dose-Response Relationship, Drug; Female; Humans; Infant, Newborn; Male; Pharmacology, Clinical; Phenobarbital; Seizures
PubMed: 26496779
DOI: 10.2174/1573397111666151026223914 -
Advances in Neurology 1980
Review
Topics: Animals; Anticonvulsants; Biotransformation; Humans; Intestinal Absorption; Phenobarbital; Rats; Tissue Distribution
PubMed: 6990708
DOI: No ID Found -
Southern Medical Journal Aug 1992Phenobarbital is a long-acting barbiturate often prescribed for seizure disorders. It has a high abuse potential and was commonly used in suicide attempts in the past.... (Review)
Review
Phenobarbital is a long-acting barbiturate often prescribed for seizure disorders. It has a high abuse potential and was commonly used in suicide attempts in the past. Although benzodiazepines are now more frequently used in suicide attempts, barbiturate intoxications are still occasionally seen and constitute a medical emergency. The management of phenobarbital overdose includes cardiac and respiratory support, cathartics, activated charcoal, and alkaline diuresis. In severely compromised patients, hemodialysis and hemoperfusion can be used to enhance drug clearance.
Topics: Drug Overdose; Humans; Phenobarbital; Suicide
PubMed: 1502622
DOI: 10.1097/00007611-199208000-00004 -
Clinics in Perinatology Mar 1975This pilot study demonstrated marked variation in neonatal phenobarbital utilization. In order to rapidly achieve therapeutic levels, it is suggested that a loading dose... (Review)
Review
This pilot study demonstrated marked variation in neonatal phenobarbital utilization. In order to rapidly achieve therapeutic levels, it is suggested that a loading dose of 8 to 10 mg per kg be administered for 2 days followed by reduction of dosage to a maintenance level of 5 to 6 mg per kg with frequent monitoring of plasma phenobarbital concentrations. The optimal plasma concentration of phenobarbital for control of neonatal seizures or withdrawal syndromes appeared to be between 15 to 30 mug per ml.
Topics: Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Phenobarbital; Pilot Projects; Seizures; Substance Withdrawal Syndrome
PubMed: 1102211
DOI: No ID Found -
Epilepsia Dec 2012This article reviews the current position of phenobarbital using articles published since 2000 and speculates on its likely future contribution to epilepsy care. Over... (Review)
Review
This article reviews the current position of phenobarbital using articles published since 2000 and speculates on its likely future contribution to epilepsy care. Over the last decade there have been no major double-blind randomized placebo-controlled or comparative trials with phenobarbital. Previous studies have suggested that phenobarbital is as effective in monotherapy as phenytoin and carbamazepine. Several observational studies undertaken in developing countries over the last decade have confirmed its efficacy and safety for the common epilepsies. This was particularly so in the substantial demonstration project undertaken in rural China under the auspices of the World Health Organization in partnership with the International League Against Epilepsy and International Bureau for Epilepsy. Phenobarbital is still widely used for neonatal and childhood seizures and for drug-resistant convulsive and nonconvulsive status epilepticus. Recent data have confirmed in a prospective cohort of women taking phenobarbital as monotherapy that the drug can be associated with a range of congenital defects in exposed infants. Much effort has gone into exploring the apparent contradiction of higher withdrawal rates due to cognitive and behavioral side effects in studies undertaken in developed countries but not in those sited in the developing world. A raft of data over the last 10 years, including a systematic review, showed no important differences between the tolerability of phenobarbital compared to that with other antiepileptic drugs. Finally, cognitive test scores and mood ratings in 136 people with epilepsy receiving phenobarbital for a year were similar to those in 137 age-, sex-, and education-matched controls in a number of Chinese villages. Indeed, there were some cognitive gains in the patients possibly due to improved seizure control. Phenobarbital is still the most cost-effective pharmacologic treatment for epilepsy. All these data predict a healthy future for phenobarbital, particularly in helping to close the treatment gap in low- and middle-income countries during its second century of clinical use.
Topics: Anticonvulsants; China; Epilepsy; Forecasting; Humans; Phenobarbital; Randomized Controlled Trials as Topic
PubMed: 23205961
DOI: 10.1111/epi.12027 -
Advances in Neurology 1980
Review
Topics: Animals; Blood Proteins; Humans; Phenobarbital; Phospholipids; Protein Binding
PubMed: 6990709
DOI: No ID Found -
BMJ (Clinical Research Ed.) Nov 2004
Topics: Anticonvulsants; Developed Countries; Developing Countries; Epilepsy; Humans; Phenobarbital
PubMed: 15550407
DOI: 10.1136/bmj.329.7476.1199 -
Epilepsy & Behavior : E&B Dec 2004
Topics: Anticonvulsants; Epilepsy; Humans; Phenobarbital
PubMed: 15582826
DOI: 10.1016/j.yebeh.2004.08.002 -
Neurology Apr 1989
Topics: Humans; Phenobarbital; Status Epilepticus
PubMed: 2927691
DOI: 10.1212/wnl.39.4.609-b -
Contact Dermatitis May 1987
Topics: Adolescent; Drug Eruptions; Eczema; Epilepsies, Partial; Female; Humans; Phenobarbital
PubMed: 2957154
DOI: 10.1111/j.1600-0536.1987.tb01455.x