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Phenobarbital
From WikEM
Contents
General
- Type: Anticonvulsant, barbiturate, barbituates
- Dosage Forms
- 65mg/mL injection
- 20mg/5 mL oral solution
- 15, 16.2, 30, 32.4, 60, 64.8, 97.2, 100mg tab
Adult Dosing
- Status epilepticus
- 20mg/kg, infuse at 50-100mg/min
- May repeat once after 10 minutes with additional 5-10mg/kg
- Alcohol withdrawal / Delirium Tremens
- 130-260mg IV q15-20 min [1]
- Seizures, maintenance dose
- 50-100mg bid-tid
Pediatric Dosing
- Status epilepticus
- 20mg/kg over 10 minutes. May repeat full dose in 15 minutes
- Seizures, maintenance dose
- ≤5 yo: 3-5mg/kg/day in 1-2 divided doses
- Children > 5 yrs: 2-3mg/kg/day in 1-2 divided doses
- Adolescents: 1-3mg/kg/day in 1-2 divided doses
Special Populations
- Pregnancy Rating: D
- Lactation: Enters breast milk, use caution
- Renal Dosing
- Adult
- GFR < 10, give every 12-16 hours
- HD: Given before HD and 50% dose after HD
- Pediatric: GFR < 10, decrease dose by 50% and give every 24 hours
- Adult
- Hepatic Dosing: Reduced dose recommended, but no defined protocols
Contraindications
- Allergy to class/drug
- Marked hepatic impairment
- Porphyria
Adverse Reactions
Serious
- Hypotension
- Respiratory depression, apnea
- Significant soft tissue injury with subcutaneous or intra-arterial administration
- Agranulocytosis
Common
- Sedation, respiratory depression
Pharmacology
- Onset: Oral 20-60 min, IV 5 min
- Peak: IV 30 min
- Half-life: Neonates 45-500 hr, Infants 20-133 hr, Children 37-73 hr, Adults 53-140 hr
- Metabolism: Hepatic
- Excretion: Urine
- Mechanism of Action: Barbituates
See Also
References
- Lexicomp, UpToDate
- ↑ Rosenson J, Clements C, Simon B, Vieaux J, Graffman S, Vahidnia F, Cisse B, Lam J, Alter H: Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo-controlled study. J Emerg Med. 2013 Mar;44(3):592-598.e2. Epub 2012 Sep 19.
