Phenobarbital: Difference between revisions
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==General== | ==General== | ||
*Type: [[Anticonvulsant]] | *Type: [[Anticonvulsant]], [[barbituates]] | ||
*Dosage Forms | *Dosage Forms | ||
**65mg/mL injection | **65mg/mL injection | ||
**20mg/5 mL oral solution | **20mg/5 mL oral solution | ||
** | **15mg, 16.2mg, 30mg, 32.4mg, 60mg, 64.8mg, 97.2mg, 100mg tab | ||
==Adult Dosing== | ==Adult Dosing== | ||
| Line 55: | Line 55: | ||
*Excretion: Urine | *Excretion: Urine | ||
*Mechanism of Action: [[Barbituates]] | *Mechanism of Action: [[Barbituates]] | ||
==Indications by Condition== | |||
''The following table is automatically generated from disease/condition pages across WikEM.'' | |||
{{#ask:[[Has DrugName::Phenobarbital]] | |||
|?Has Indication=Indication | |||
|?Has Dose=Dose | |||
|?Has Context=Context | |||
|?Has Route=Route | |||
|?Has Population=Population | |||
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==See Also== | ==See Also== | ||
Latest revision as of 21:56, 20 March 2026
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
- 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
Indications by Condition
The following table is automatically generated from disease/condition pages across WikEM.
| Indication | Dose | Context | Route | Population |
|---|---|---|---|---|
| Delirium tremens | 65mg, then 130mg, then 260mg q5-10min | Second-line if still agitated after 200mg diazepam | IV | Adult |
| Ethanol withdrawal | 130-260 mg IV q15-20min; or 10 mg/kg IV loading dose as 1st line | Refractory to benzodiazepines / 1st line load | IV | Adult |
| Neonatal abstinence syndrome | 16mg/kg load (divided into 2 feeds day 1), then 2-8mg/kg/day maintenance | Adjunctive or alternative sedation | IV/PO | Pediatric |
See Also
External Links
ACEP: Phenobarbital for Alcohol Withdrawal
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.