Phenobarbital

Phenobarbital Brand Name– Luminal

What is Phenobarbital

Phenobarbital is an oral and parenteral barbiturate with anticonvulsant and sedative-hypnotic properties.

Phenobarbital is the oldest of the commonly used anticonvulsants. It is also the longest-acting agent in the barbiturate group.

In general, phenobarbital is effective in all seizure disorders except absence (petit mal). It was regularly prescribed to prevent febrile seizures but now is infrequently used for this due to side effects and lack of efficacy.

In pediatric patients, it often is used alone; in adults, it usually is administered in combination with other agents.

Phenobarbital was first used as an anticonvulsant in 1912, and it was approved by the FDA in 1939. Its use as an anticonvulsant in children and adolescents has gradually declined due to concerns over its effects on learning.

Indications

1. hyperbilirubinemia
2. insomnia
3. myoclonic seizures
4. neonatal abstinence syndrome
5. partial seizures
6. procedural sedation
7. sedation maintenance
8. status epilepticus
9. tonic-clonic seizures

For the treatment of status epilepticus

Side Effects

1. agitation
2. agranulocytosis
3. anemia
4. anxiety
5. asthenia
6. ataxia
7. bradycardia
8. bullous rash
9. coma
10. confusion
11. constipation
12. depression
13. diarrhea
14. dizziness
15. drowsiness
16. ecchymosis
17. elevated hepatic enzymes
18. emotional lability
19. erythema
20. exfoliative dermatitis
21. fatigue
22. folate deficiency
23. headache
24. hepatitis
25. hypoprothrombinemia
26. hypotension
27. impaired cognition
28. impotence (erectile dysfunction)
29. injection site reaction
30. insomnia
31. interstitial nephritis
32. irritability
33. jaundice
34. lethargy
35. libido decrease
36. lupus-like symptoms
37. maculopapular rash
38. megaloblastic anemia
39. miosis
40. mydriasis
41. nausea
42. neonatal abstinence syndrome
43. neutropenia
44. nightmares
45. nystagmus
46. osteomalacia
47. osteopenia
48. phlebitis
49. photosensitivity
50. physiological dependence
51. porphyria
52. psychological dependence
53. ptosis
54. purpura
55. respiratory depression
56. serum sickness
57. Stevens-Johnson syndrome
58. suicidal ideation
59. teratogenesis
60. thrombocytopenia
61. tissue necrosis
62. tolerance
63. toxic epidermal necrolysis
64. urticaria
65. vertigo
66. vitamin D deficiency
67. vomiting
68. weakness
69. withdrawal

Monitoring Parameters

• CBC
• LFTs
• serum creatinine/BUN
• serum phenobarbital concentrations

Contraindications

• abrupt discontinuation
• agranulocytosis
• alcoholism
• anticoagulant therapy
• anuria
• barbiturate hypersensitivity
• breast-feeding
• carbamazepine hypersensitivity
• cardiac disease
• children
• chronic obstructive pulmonary disease (COPD)
• CNS depression
• coadministration with other CNS depressants
• depression
• dialysis
• driving or operating machinery
• ethanol ingestion
• exfoliative dermatitis
• geriatric
• heart failure
• hepatic disease
• hepatic encephalopathy
• hydantoin hypersensitivity
• hypertension
• hypotension
• infants
• intraarterial administration
• intravenous administration
• labor
• neonates
• obstetric delivery
• osteomalacia
• osteoporosis
• pain
• porphyria
• pregnancy
• premature neonates
• pulmonary disease
• renal failure
• renal impairment
• respiratory depression
• seizure disorder
• seizures
• shock
• sleep apnea
• status epilepticus
• subcutaneous administration
• substance abuse
• suicidal ideation

Interactions

• Abacavir; Dolutegravir; Lamivudine
• Abemaciclib
• Abiraterone
• Acalabrutinib
• Acetaminophen
• Acetaminophen; Aspirin, ASA; Caffeine
• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan
• Acetaminophen; Dextromethorphan; Doxylamine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Dichloralphenazone; Isometheptene
• Acetaminophen; Diphenhydramine
• Acetaminophen; Guaifenesin; Phenylephrine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Pentazocine
• Acetaminophen; Propoxyphene
• Acetaminophen; Pseudoephedrine
• Acetaminophen; Tramadol
• Acetazolamide
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• Afatinib
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• Trimethobenzamide
• Trimetrexate
• Triprolidine
• Tucatinib
• Ubrogepant
• Ulipristal
• Upadacitinib
• Valbenazine
• Valerian, Valeriana officinalis
• Valproic Acid, Divalproex Sodium
• Vandetanib
• Vemurafenib
• Venetoclax
• Verapamil
• Vigabatrin
• Vilazodone
• Vincristine
• Vincristine Liposomal
• Vorapaxar
• Voriconazole
• Vortioxetine
• Voxelotor
• Warfarin
• Zaleplon
• Zanubrutinib
• Ziconotide
• Ziprasidone
• Zolpidem
• Zonisamide