Phenobarbital

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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
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  • Remifentanil
  • Repaglinide
  • Reserpine
  • Ribociclib
  • Ribociclib; Letrozole
  • Rifampin
  • Rifapentine
  • Rilpivirine
  • Riluzole
  • Rimegepant
  • Riociguat
  • Ripretinib
  • Risperidone
  • Ritonavir
  • Rivaroxaban
  • Roflumilast
  • Rolapitant
  • Romidepsin
  • Ropinirole
  • Ropivacaine
  • Rotigotine
  • Rucaparib
  • Rufinamide
  • Ruxolitinib
  • Safinamide
  • Salicylates
  • Salsalate
  • Sapropterin
  • Saquinavir
  • Scopolamine
  • Segesterone Acetate; Ethinyl Estradiol
  • Selegiline
  • Selpercatinib
  • Selumetinib
  • Sertraline
  • Sildenafil
  • Simeprevir
  • Simvastatin
  • Simvastatin; Sitagliptin
  • Siponimod
  • Sirolimus
  • Skeletal Muscle Relaxants
  • Sodium Oxybate
  • Sofosbuvir
  • Sofosbuvir; Velpatasvir
  • Sofosbuvir; Velpatasvir; Voxilaprevir
  • Sonidegib
  • Sorafenib
  • Spironolactone
  • Sufentanil
  • Sunitinib
  • Suvorexant
  • Tacrolimus
  • Tadalafil
  • Tamoxifen
  • Tapentadol
  • Tasimelteon
  • Tazemetostat
  • Telaprevir
  • Telithromycin
  • Telotristat Ethyl
  • Temazepam
  • Temsirolimus
  • Teniposide
  • Tenofovir Alafenamide
  • Tenofovir Alafenamide
  • Terbinafine
  • Tetrabenazine
  • Tetracaine
  • Tezacaftor; Ivacaftor
  • Thalidomide
  • Theophylline, Aminophylline
  • Thiazide diuretics
  • Thiotepa
  • Thiothixene
  • Thyroid hormones
  • Tiagabine
  • Ticagrelor
  • Tinidazole
  • Tipranavir
  • Tizanidine
  • Tofacitinib
  • Tolcapone
  • Tolvaptan
  • Topiramate
  • Toremifene
  • Trabectedin
  • Tramadol
  • Trandolapril; Verapamil
  • Tranylcypromine
  • Trazodone
  • Tretinoin, ATRA
  • Triamcinolone
  • Triazolam
  • Triclabendazole
  • Tricyclic antidepressants
  • 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

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