Phenobarbital is a seizure medicine manufactured by several companies
It is the oldest epilepsy medicine still in use. In 1912, two independent teams of chemists created it under the name of Luminal.
The advantages of phenobarbital are its long history of use, low cost, and effectiveness. It stays in the body for a long time, so the amount of medicine in the blood stays fairly steady even if it is taken only once a day.
A disadvantage is that it makes many people sleepy and sometimes causes other changes in behavior. Not everyone is affected the same way, however, and many individuals do well when they take phenobarbital. Another problem is that after people take it for a while, they must be very careful if they want to stop taking it. They could have withdrawal seizures. The doctor will recommend a very slow reduction in the dose to prevent these seizures.
The same medicine is available in several forms because people's needs vary. The name or appearance may differ from country to country, or even from manufacturer to manufacturer, but usually the dose (measured in milligrams, abbreviated 'mg') will be the same.
Why is Phenobarbital prescribed?
- It is used to control seizures.
- It is also used to relieve anxiety.
- It is also used to prevent withdrawal symptoms in people who are dependent ('addicted'; feel a need to continue taking the medication) on another barbiturate medication and are going to stop taking the medication.
- It is in a class of medications called barbiturates.
- It works by slowing activity in the brain.
|Phenobarbital may cause a severe allergic reaction. Stop taking phenobarbital and get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, eyes, lips, tongue, or throat.|
Call your doctor at once if you have:
|Side effects such as confusion, depression, or excitement may be more likely in older adults and those who are ill or debilitated.|
Common side effects may include:
|This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.|
|Prescribers Digital Reference|
|Adults:||Specific maximum dosage information not available; individualize dosage based on monitoring of serum phenobarbital concentrations and clinical parameters. 200 mg/day PO is a general estimation for outpatient chronic use.|
|Geriatric:||Specific maximum dosage information not available; individualize dosage based on monitoring of serum phenobarbital concentrations and clinical parameters. 200 mg/day PO is a general estimation for outpatient chronic use.|
|Adolescents:||Specific maximum dosage information not available; individualize dosage based on monitoring of serum phenobarbital concentrations and clinical parameters. For status epilepticus, single doses do not usually exceed 20 mg/kg IV (Max: 1,000 mg/dose); for anticonvulsant maintenance treatment, doses above 6 mg/kg/day are not usually necessary.|
|Children:||Specific maximum dosage information not available; individualize dosage based on monitoring of serum phenobarbital concentrations and clinical parameters. For status epilepticus, single doses do not usually exceed 20 mg/kg IV (Max: 1,000 mg/dose); for anticonvulsant maintenance treatment, doses above 8 (7 years and older) to 10 mg/kg/day (6 years and younger) are not usually necessary.|
|Infants:||Specific maximum dosage information not available; individualize dosage based on monitoring of serum phenobarbital concentrations and clinical parameters. For status epilepticus, single doses do not usually exceed 20 mg/kg IV; for anticonvulsant maintenance treatment, doses above 10 mg/kg/day are not usually necessary.|
|Neonates:||Specific maximum dosage information not available; individualize dosage based on monitoring of serum phenobarbital concentrations and clinical parameters. For status epilepticus, single doses do not usually exceed 20 mg/kg IV; for anticonvulsant maintenance treatment, doses above 5 mg/kg/day are not usually necessary.|
Occurs when someone intentionally or accidentally takes too much of it. Barbiturates are addictive, producing physical dependence and a withdrawal syndrome that can be life-threatening. If you or someone you are with overdoses, call your local emergency number (such as 911), or your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States.
Overdose Outlook (Prognosis):
How well the person does depends on the severity of the overdose and how quickly treatment is received. With proper treatment, people can recover in 1 to 5 days. If there has been prolonged coma and shock (damage to multiple internal organs), a more serious outcome is possible.
Phenobarbital is a type of sedative that is not commonly used except for seizure disorders. It has a higher potential for abuse than newer sedatives, like benzodiazepines, and can cause dangerous and even fatal overdoses. Any misuse of phenobarbital can lead to an overdose, but the biggest risk comes from combining it with other sedatives like opioids and alcohol. A phenobarbital overdose is an emergency that can cause difficulty breathing and heart problems. It should be treated immediately.
Phenobarbital is a prescription drug sold under the brand name Luminal. It belongs to a class of drugs called barbiturates. It is approved to treat seizure disorders and works by slowing down activity in the brain.Some people misuse barbiturates to get the relaxed, euphoric sensation that comes with relaxation of the central nervous system. Misuse of phenobarbital can cause reduced inhibitions, poor coordination, poor judgement, sleepiness, memory impairment, and eventually addiction. Any misuse of phenobarbital comes with the very real risk of an overdose that could be fatal. Any central nervous system depressant like phenobarbital can be fatal if taken in a large does. The amount that will trigger an overdose varies by individual. Factors that affect overdose include the duration of misuse, degree of tolerance, and individual aspects of health. In anyone, an overdose on phenobarbital can be fatal and should be treated as a medical emergency.
Well absorbed after oral administration, with 70% to 90% reaching bloodstream. 100% absorption after I.M. administration. After oral administration, serum levels peak in 1 to 2 hours; levels in CNS peak at 1 to 3 hours. Serum level of 10 mcg/ml needed to produce sedation; 40 mcg/ml usually produces sleep. Levels of 20 to 40 mcg/ml considered therapeutic for anticonvulsant therapy.
Distributed widely throughout body. About 25% to 30% protein-bound.
Metabolized by hepatic microsomal enzyme system.
25% to 50% of dose eliminated unchanged in urine; remainder excreted as metabolites of glucuronic acid. Drug's half-life is 5 to 7 days.
Overdose and treatment:
Toxicity may cause:
Typical shock syndrome with tachycardia and hypotension along with jaundice, oliguria, and chills followed by fever may occur. Treatment aims to maintain and support ventilation and pulmonary function as needed; and to support cardiac function and circulation with vasopressors and IV fluids as needed. If patient is conscious and gag reflex is intact, induce emesis (if ingestion was recent) by administering ipecac syrup. If emesis is contraindicated, perform gastric lavage while a cuffed endotracheal tube is in place to prevent aspiration. Follow with administration of activated charcoal or sodium chloride cathartic. Measure intake and output, vital signs and laboratory parameters. Maintain body temperature. Alkalinization of urine may be helpful in removing drug from body; hemodialysis may be useful in severe overdose. Oral activated charcoal may enhance drug elimination regardless of its route of administration.
- Unsteady gait
- Slurred speech
- Sustained nystagmus
- Respiratory depression
- Pulmonary edema
- A type of seizure disorder called tonic-clonic epilepsy
- Simple partial seizures
- High amount of bilirubin in the blood
This medication is used alone or with other medications to control seizures.
Controlling and reducing seizures lets you do more of your normal daily activities, reduces your risk of harm when you lose consciousness, and lessens your risk for a possibly life-threatening condition of frequent, repeated seizures.Phenobarbital belongs to a class of drugs known as barbiturate anticonvulsants/hypnotics. It works by controlling the abnormal electrical activity in the brain that occurs during a seizure.
This medication is also used for a short time (usually no more than 2 weeks) to help calm you or help you sleep during periods of anxiety. It works by affecting certain parts of the brain to cause calming.
Tell your doctor or pharmacist your medical history, especially of:
- Certain hormone problems (adrenal disease such as Addison's disease)
- Liver problems
- Kidney problems
- Lung disease (such as sleep apnea, chronic obstructive pulmonary disease-COPD)
- Mental/mood disorders (such as depression, thoughts of suicide)
- Ppersonal or family history of a substance use disorder (such as overuse of or addiction to drugs/alcohol)
- Personal/family history of a certain blood disorder (porphyria)
- Certain vitamin deficiencies (folic acid, vitamin K)
- This drug may make you dizzy or drowsy.
- Alcohol or marijuana (cannabis) can make you more dizzy or drowsy.
- Do not drive, use machinery, or do anything that needs alertness until you can do it safely.
- Avoid alcoholic beverages.
- Talk to your doctor if you are using marijuana (cannabis).
The liquid form of this product may contain alcohol or sugar. Caution is advised if you have diabetes, alcohol dependence, liver disease, or any other condition that requires you to limit/avoid these substances in your diet. Ask your doctor or pharmacist about using this product safely.
77 Total User Reviews Phenobarbital Oral Read Reviews Condition: Epileptic Seisure (31 Reviews): Effectiveness (4.10) Ease of Use (4.45) Satisfaction (3.61)
You should not use phenobarbital if you have severe liver disease, severe asthma or COPD, a personal or family history of porphyria, or a history of addiction to drugs similar to phenobarbital.
Drinking alcohol with phenobarbital can cause side effects.This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.
Drug Interactions (676) Alcohol/Food Interactions (2) Disease Interactions (15)
What other drugs will affect Phenobarbital?
Taking phenobarbital with other drugs that make you sleepy or slow your breathing can cause dangerous or life-threatening side effects. Ask your doctor before taking phenobarbital with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures. Other drugs may interact with phenobarbital, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.
A total of 676 drugs are known to interact with Phenobarbital.
- 170 major drug interactions
- 461 moderate drug interactions
- 45 minor drug interactions
What is the most important information I should know about Phenobarbital:
You should not take this medicine if you are allergic to phenobarbital or other barbiturates (Nembutal, Seconal, and others), or if you have:
- Severe asthma, chronic obstructive pulmonary disorder (COPD), or other breathing disorder
- A personal or family history of porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system)
- Severe liver disease
- A history of addiction to phenobarbital or similar medicines (Valium, Xanax, Ativan, and others)
To make sure phenobarbital is safe for you, tell your doctor if you have:
- Liver disease
- Temporary or chronic pain
- A pituitary gland disorder
- Pheochromocytoma (tumor of the adrenal gland)
- Kidney disease
- A food or drug allergy
- A condition for which you take a blood thinner (warfarin, Coumadin, Jantoven)
Follow your doctor's instructions about taking seizure medication if you are pregnant. Seizure control is very important during pregnancy, and having a seizure could harm both mother and baby. Do not start or stop taking this medicine without your doctor's advice, and tell your doctor right away if you become pregnant.
Phenobarbital can make birth control pills less effective. Ask your doctor about using a non-hormonal birth control (condom, diaphragm with spermicide) to prevent pregnancy.
It is not known whether phenobarbital passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.
CNS depressant that is used mostly for insomnia (In older patients) and epliepsy (in younger patients) And it a very strong narcotic, that can be taken most ways. It's used less as 'safer' alternatives have been made (Benzodiazepines).
|Oral:||15-45 minutes||5-8 hours||1-24 hours|
|Intravenous:||1-5 minutes||4-6 hours||1-24 hours|
All other CNS depressants.
Phenobarbital is a long-acting barbiturate:
Typically prescribed to control seizures. In some circumstances, it is used in treating withdrawal and for other purposes. Knowing how it acts in your system and for how long can help you understand the precautions to take to avoid dangerous drug interactions and possible overdoses.
How Phenobarbital Acts in Your System:
Phenobarbital can be administered as an injection, a liquid elixir, or tablets. Each has their own speed of taking effect and appropriate dosages. Tablets or elixirs begin to act in about 60 minutes, and their duration lasts for 10 to 12 hours, depending on the dosage and individual metabolism.
Phenobarbital is metabolized by the liver and excreted in the urine. It can be detected in the urine for up to 15 days after a dose. If you take a urine drug screen while on phenobarbital, it will likely test positive for barbiturates.
The plasma half-life of phenobarbital in adults is an average of about 79 hours and 110 hours in children. That means that only half of the active ingredients have stopped exerting their effect in that time. It takes about 4 to 5 half-lives for drugs to be fully eliminated from your system.
Phenobarbital is a relatively fast-acting barbiturate drug. This means that individuals who use the drug will feel its effects rather quickly, and the effects may not last as long as the effects of other similar types of drugs. This can result in individuals bingeing on the drug in order to maintain its effects or using it in combination with other drugs, such as alcohol.
Using phenobarbital is associated with a number of psychoactive effects. Individuals who abuse the drug often experience symptoms that are extremely similar to drinking moderate to heavy amounts of alcohol, such as being giddy, having fewer inhibitions, slurring their words, experiencing issues with motor coordination, etc. Using larger amounts of phenobarbital can result in aggressiveness, irritability, lethargy, and unconsciousness or coma.
Prescription medications can save your life if they are used properly. Unfortunately many of them can be addictive and habit forming if they are misused or abused. Phenobarbital, a commonly abused prescription medication, is not only physically addictive, but mentally addictive as well. This addiction and dependence is due, in part, to the tolerance that so often results from abuse. With a heightened tolerance to phenobarbital, individuals using the drug will take more than prescribed to achieve the same effects as when they first started using it. Also known as Luminal and Bellergal-S, phenobarbital is a long-acting barbiturate which depresses the central nervous system and treats over activity of your brain.
In medicine, phenobarbital can be used to treat epilepsy, anxiety and insomnia. It's also widely used in veterinary practices to treat dogs with epilepsy. Phenobarbital was also once the primary medication used in treatment of acute withdrawal symptoms.Nowadays barbiturates 'are used less frequently to reduce anxiety or to help with sleep problems because of their higher risk of overdose compared to benzodiazepines' (National Institute on Drug Abuse). That being said, benzodiazepines have mostly replaced barbiturates for management of sedative withdrawal syndrome.
Phenobarbital is a type of tranquilizer that can make a person feel tired, relaxed and comfortable. In the world of drug abuse, the calm feeling that comes from barbiturates is what keeps people using them.
Phenobarbital has been linked to rare instances of idiosyncratic liver injury that can be severe and even fatal.
Prospective studies suggest that less than 1% of subjects develop elevations in serum aminotransferase levels during long term phenobarbital therapy. Clinically apparent hepatotoxicity from phenobarbital is rare but can be abrupt in onset, severe and even fatal. Phenobarbital hepatotoxicity typically occurs in the setting of anticonvulsant hypersensitivity syndrome with onset of fever, rash, facial edema, lymphadenopathy, elevations in white count and eosinophilia occurring 1 week to several months after starting therapy. Liver involvement is common, but is usually mild and anicteric and overshadowed by other features of hypersensitivity (rash, fever). In some cases, hepatic involvement is more prominent with marked elevations in serum enzyme levels, jaundice and even signs of hepatic failure. The typical pattern of serum enzyme elevations is mixed, but can be hepatocellular or cholestatic. Liver biopsy shows mixed hepatitis-cholestatic injury with prominence of eosinophils and occasionally granulomata. Re-exposure usually results in recurrence and should be avoided.
B Likelihood score: B (likely rare cause of clinically apparent liver injury).
Phenobarbital drug monitoring:
- Phenobarbital is used to treat epilepsy in children and adults.
- Epilepsy is a disease that causes brain seizures or convulsions.
- Phenobarbital may be used to treat different types of seizures, including tonic-clonic, complex, partial, or myoclonic seizures.
- Other names for medicines containing phenobarbital include Luminal and Mysoline.
If you take phenobarbital to keep seizures under control, the amount of phenobarbital in your blood needs to be at the right level. This level is called the therapeutic range. The therapeutic range has a low number, or concentration, and a high number. If your blood level is less than the low number you may be more likely to have a seizure. If it is above the high number, you may be more likely to have side effects.
Blood levels of phenobarbital:
Blood levels of phenobarbital will be checked regularly to reduce side effects and to improve treatment. It is best to draw blood for these checks just before the next dose is due. Therefore, do not take your next scheduled dose until after the blood sample has been drawn. Your dose of phenobarbital may change based on the blood level.
Summary of Use During Lactation:
Inter- and intrapatient variability in excretion of phenobarbital into breastmilk is extensive.
Phenobarbital in breastmilk apparently can decrease withdrawal symptoms in infants who were exposed in utero, but it can also cause drowsiness in some infants, especially when used with other sedating drugs.Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of psychotropic drugs.
Sometimes breastfeeding might have to be limited or discontinued because of excessive drowsiness and poor weight gain. If there is concern, measurement of the infant's serum phenobarbital concentration might help rule out toxicity.
In published reports of anticonvulsant use during breastfeeding, most women were taking a combination of anticonvulsants. Some other anticonvulsants (e.g., phenytoin, carbamazepine) stimulate the metabolism of other drugs including anticonvulsants, whereas others (e.g., valproic acid) inhibit the metabolism of other drugs. Therefore, the relationship of the maternal dosage to the concentration in breastmilk can be quite variable, making calculation of the weight-adjusted percentage of maternal dosage less meaningful than for other drugs in this database.
Effects on Lactation and Breastmilk:
No direct effect is known, but mothers taking antiepileptic drugs stop breastfeeding earlier and supplement more than mothers not taking antiepileptic drugs.
Most of these reports occurred in older studies in which sedating agents such as phenobarbital and primidone were used.Infant sucking difficulties and sedation were reasons given for the reduced nursing.
Alternate Drugs to Consider:
- (Sedative) Lorazepam
- (Seizure Disorder) Carbamazepine
- Valproic Acid
Bulletin of the World Health Organization (2012):
Epilepsy affects more than 60 million people worldwide:
Over 80% of them live in resource-poor countries. Approximately 85% of these people do not receive appropriate treatment because of economic, cultural, social and legislative barriers, compounded by little interest on the part of pharmaceutical companies because drug distribution is not lucrative. Left untreated, people with epilepsy face devastating social consequences, including stigma and discrimination, and can even die from seizures. The morbidity and premature mortality associated with epilepsy and the large economic burden the disease imposes on health-care systems can only be mitigated by making effective antiepileptic treatment widely available.
An effective method of epilepsy control is clearly needed to fill the epilepsy treatment gap worldwide. Phenobarbital is efficacious, convenient to use and cost-effective with side-effects which are frequently tolerable. As some have noted, in low-resource countries 'the choice is not between phenobarbital and a new medicament, but between phenobarbital and no treatment at all'.
- Phenobarbital, an effective anti-epileptic drug, has been used since the early twentieth century.
- Its relatively low cost and favourable cost - efficacy ratio, which is lower than that of any other anti-epileptic drug in current use, makes the drug affordable and suitable for use in low- and middle-income countries, where cost-effectiveness often supersedes other priorities.
- In addition, the drug's half-life allows for the use of a single daily dose, which is convenient.
The World Health Organization (WHO) recommends phenobarbital as a first-line treatment for convulsive seizures in resource-poor countries and includes it in its Model Lists of Essential Medicines. Accordingly, a continuous supply of phenobarbital of assured quality in appropriate dosage forms should be available in all of WHO's Member States, duly accompanied by information on its use.
- Phenobarbital controls seizures effectively.
- Despite the advantages of phenobarbital, the epilepsy treatment gap is large.
- Phenobarbital's adverse effects, especially capacity to alter mood and neurocognitive function, have generated concern. A recent study, however, showed no significant difference between treatment and control subjects in cognitive and mood test scores.
Before giving phenobarbital to your child?
Tell your child's doctor if your child has:
- Allergies to phenobarbital
- Porphyria (a problem with enzymes that make red blood cells)
- Difficulty breathing
- Kidney disease
- Liver disease
When should the medicine start working?
It may take a few weeks for phenobarbital to work properly, so your child may still have seizures during this time. This is because the amount of medicine has to be increased slowly. Continue to give the medicine in the way you have been told to by your doctor or epilepsy nurse. Phenobarbital may not stop your child's seizures completely. If you are worried about whether it is helping, contact your doctor but continue to give the medicine.
What if my child is sick (vomits)?
- If your child is sick less than 30 minutes after taking a dose of phenobarbital, give the same dose again.
- If your child is sick more than 30 minutes after taking a dose of phenobarbital, you do not need to give them another dose. Wait until the next normal dose.
Phenobarbital (brand names: Luminal Sodium, Solfoton, Tedral; alternative generic names: phenobarbitone, fenobarbital, phenemalum, phenobarbitalum, phenylethylbarbituric acid, phenylethylmalonylurea) is a barbiturate used to treat seizures and as a sedative in cats, dogs, ferrets, and horses. Its use in small and large animals to treat seizures or as a sedative is 'off label' or 'extra label'. Many drugs are commonly prescribed for off label use in veterinary medicine. In these instances, follow your veterinarian's directions and cautions very carefully as their direction may be significantly different from those on the label.
Pet side effects?
Common side effects in dogs include anxiety, agitation, lethargy, or sedation when therapy is started, and increased thirst, urination, and appetite or elevated liver enzymes on bloodwork are possible. Side effects such as incoordination may indicate a dose that is too high. Less commonly, decreased blood cell counts may occur. Although rare, if signs of liver dysfunction are observed (yellowing of the skin, vomiting, anorexia, abnormal bloodwork, skin ulcers) or liver enzymes are 4-5 times higher than normal on bloodwork, a different medication should be started immediately and phenobarbital discontinued.
Cats can exhibit incoordination, sedation, lethargy, facial itchiness, increased appetite and associated weight gain, and increased thirst and urination. Rarely, cats can have decreased blood cell counts on bloodwork.
This moderate-acting medication should stop working in a few days, although effects can be longer in pets with liver or kidney disease.Phenobarbital can alter the results of some thyroid and Cushing's testing.
Phenobarbital is used to control epilepsy in your pet:
It may be used alone or in conjuction with other drugs to reduce the number and severity of your pet's seizures. A seizure is a sudden surge in neuron activity in the brain, causing a change in feeling or behavior. Phenobarbital decreases and stabilizes neuron activity, decreasing the amount of seizures your pet experiences.
Phenobarbital's neuron decreasing effects may also decrease other neurons, resulting in lethargy and other unwanted side effects. Closelt monitor your pet while they are on this drug.
Phenobarbital is only found in individuals that have used or taken this drug. It is a barbituric acid derivative that acts as a nonselective central nervous system depressant. Phenobarbital acts on GABAA receptors, increasing synaptic inhibition. This has the effect of elevating seizure threshold and reducing the spread of seizure activity from a seizure focus. Phenobarbital may also inhibit calcium channels, resulting in a decrease in excitatory transmitter release. The sedative-hypnotic effects of phenobarbital are likely the result of its effect on the polysynaptic midbrain reticular formation, which controls CNS arousal. Belongs to the class of organic compounds known as barbituric acid derivatives.
Phenobarbital was discovered in 1912 and is the oldest still commonly used anti-seizure medication. It is on the World Health Organization's List of Essential Medicines. It is the least expensive anti-seizure medication at around US $5 a year in the developing world. Access, however, may be difficult as some countries label it as a controlled drug.
- A barbiturate.
- In the developed world, it is commonly used to treat seizures in young children, while other medications are generally used in older children and adults.
- Phenobarbital is occasionally used to treat trouble sleeping, anxiety, and drug withdrawal and to help with surgery.
- It usually begins working within five minutes when used intravenously and half an hour when administered by mouth.
- Its effects last for between four hours and two days.
- Side effects include a decreased level of consciousness along with a decreased effort to breathe.
- There is concern about both abuse and withdrawal following long-term use.
- It may also increase the risk of suicide.
- If used during breastfeeding it may result in drowsiness in the baby.
- A lower dose is recommended in those with poor liver or kidney function, as well as elderly people.
March 1997: Thirty-nine members of the Heaven's Gate UFO religious group committed mass suicide by drinking a lethal dose of phenobarbital and vodka "and then lay down to die" hoping to enter an alien spacecraft.
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