Phenobarbital: Difference between revisions
 
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==General==
==General==
*Type: Anticonvulsant, barbiturate, [[barbituates]]
*Type: [[Anticonvulsant]], [[barbituates]]
*Dosage Forms
*Dosage Forms
**65 mg/mL injection
**65mg/mL injection
**20 mg/5 mL oral solution
**20mg/5 mL oral solution
**15, 16.2, 30, 32.4, 60, 64.8, 97.2, 100 mg tab
**15mg, 16.2mg, 30mg, 32.4mg, 60mg, 64.8mg, 97.2mg, 100mg tab


==Adult Dosing==
==Adult Dosing==
*[[Status epilepticus]]
*[[Status epilepticus]]
**20 mg/kg, infuse at 50-100 mg/min
**20mg/kg, infuse at 50-100mg/min
**May repeat once after 10 minutes with additional 5-10 mg/kg
**May repeat once after 10 minutes with additional 5-10mg/kg
*[[Alcohol withdrawal]] / Delirium Tremens
*[[Alcohol withdrawal]] / Delirium Tremens
**130-260 mg IV q15-20 min <ref> 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. </ref>
**Loading dose of 10 mg/kg combined with a standardized lorazepam-based alcohol withdrawal protocol decreases ICU admissions<ref>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. </ref>
**130-260mg IV q15-20 min
*Seizures, maintenance dose
*Seizures, maintenance dose
**50-100 mg bid-tid
**50-100mg bid-tid


==Pediatric Dosing==
==Pediatric Dosing==
*[[Status epilepticus]]
*[[Status epilepticus]]
**20 mg/kg over 10 minutes. May repeat full dose in 15 minutes
**20mg/kg over 10 minutes. May repeat full dose in 15 minutes
*Seizures, maintenance dose
*Seizures, maintenance dose
**≤5 yo: 3-5 mg/kg/day in 1-2 divided doses
**≤5 yo: 3-5mg/kg/day in 1-2 divided doses
**Children > 5 yrs: 2-3 mg/kg/day in 1-2 divided doses
**Children > 5 yrs: 2-3mg/kg/day in 1-2 divided doses
**Adolescents: 1-3 mg/kg/day in 1-2 divided doses
**Adolescents: 1-3mg/kg/day in 1-2 divided doses


==Special Populations==
==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]:
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: D
*Lactation:
*Lactation: Enters breast milk, use caution
*Renal Dosing
*Renal Dosing
**Adult
**Adult
**Pediatric
***GFR < 10, give every 12-16 hours
*Hepatic Dosing
***HD: Given before HD and 50% dose after HD
**Adult
**Pediatric: GFR < 10, decrease dose by 50% and give every 24 hours
**Pediatric
*Hepatic Dosing: Reduced dose recommended, but no defined protocols


==Contraindications==
==Contraindications==
*Allergy to class/drug
*Allergy to class/drug
*Marked hepatic impairment
*Porphyria


==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
 
*Hypotension
*Respiratory depression, apnea
*Significant soft tissue injury with subcutaneous or intra-arterial administration
*Agranulocytosis
===Common===
===Common===
*Sedation, respiratory depression


==Pharmacology==
==Pharmacology==
*Half-life:  
*Onset: Oral 20-60 min, IV 5 min
*Metabolism:  
*Peak: IV 30 min
*Excretion:  
*Half-life: Neonates 45-500 hr, Infants 20-133 hr, Children 37-73 hr, Adults 53-140 hr
*Mechanism of Action:
*Metabolism: Hepatic
*Excretion: Urine
*Mechanism of Action: [[Barbituates]]


==See Also==
==See Also==
*[[Barbituates]]
*[[Alcohol withdrawal]]
*[[Status epilepticus]]
==External Links==
[https://www.acep.org/how-we-serve/sections/critical-care-medicine/news/july-2018/phenobarbital-for-alcohol-withdrawal/ ACEP: Phenobarbital for Alcohol Withdrawal]


==Sources==
==References==
 
*Lexicomp, UpToDate
<references/>
<references/>
[[Category:Drugs]]
[[Category:Pharmacology]]

Latest revision as of 00:34, 7 March 2021

General

  • Type: Anticonvulsant, barbituates
  • Dosage Forms
    • 65mg/mL injection
    • 20mg/5 mL oral solution
    • 15mg, 16.2mg, 30mg, 32.4mg, 60mg, 64.8mg, 97.2mg, 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
    • Loading dose of 10 mg/kg combined with a standardized lorazepam-based alcohol withdrawal protocol decreases ICU admissions[1]
    • 130-260mg IV q15-20 min
  • 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
  • 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

External Links

ACEP: Phenobarbital for Alcohol Withdrawal

References

  • Lexicomp, UpToDate
  1. ↑ 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.
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