Phenobarbital

Details About Generic Salt ::  Phenobarbital 

Main Medicine Class:: Nervous System   Sub Medicine Class ::  Sedatives , Hypnotics

1A. SEDATIVES & HYPNOTICS in 1. NERVOUS SYSTEM
PHENOBARBITAL
BARBITURATE | SEDATIVE, HYPNOTIC, ANTI-EPILEPTIC
also comes under 1C. Anti-Epileptics in 1. Nervous System
PK: A: PO: 70-90% M: Hepatic E: Urine (20-50% as unchanged drug)

Indications & Dose: FEBRILE CONVULSIONS PO Child 8mg/kg/day | GENERALIZED TONIC–CLONIC SEIZURES PO Adult 60–180mg HS Child 8mg/kg/day | HYPNOTIC PO Adult 100-320mg HS | IV/IM Adult 100-320mg HS Child 3-5mg/kg HS | NEONATAL SEIZURES IV Child 5–10mg/kg q20-30mins up to plasma concentration of 40mg/L | PARTIAL SEIZURES PO Adult 60–180mg HS Child 8mg/kg/day | PREOPERATIVE SEDATION PO/IV Child 1-3mg/kg 1-1.5h before procedure | IM Adult 100-200mg 1-1.5h before procedure Child 1-3 mg/kg 1-1.5h before procedure | SEDATION PO Adult 30-120mg/day in 2-3 divided doses. Child 2mg/kg TID | IM Adult 30-120mg/day in 2-3 divided doses | SEIZURES Acute Emergency therapy IV General 60mg/min | Acute Emergency therapy IM General 200mg q6h | STATUS EPILEPTICUS IV Adult Loading dose: 10-20mg/kg (max rate <60mg/min in patient’s >60 kg), repeat dose q20min if needed, max 30mg/kg Child 15-20mg/kg (max rate <30 mg/min in children <60 kg), repeat dose after 15min as needed, max 40mg/kg

Contra: Hypersensitivity to barbiturates, porphyria, severe hepatic impairment, absence seizures, airway obstruction, intra-arterial & SC administration, history of sedative/hypnotic addiction, nephritis

Precautions: Elderly/debilitated, children, renal impairment, respiratory depression, sudden withdrawal, rapid IV administration

ADR: Serious: Bradycardia, hypotension, exfoliative dermatitis, SJS, thrombophlebitis, laryngospasm, respiratory depression, oliguria, gangrene, CNS excitation/depression, Others: Rash, syncope, dizziness, drowsiness, hallucinations, hangover effect, headache, hyperkinesia, impaired judgment, insomnia, nightmares, blood disorders, anxiety, hypoventilation, nausea, vomiting

DDI: Serious Griseofulvin activity reduces, Combined hormonal contraceptives causes bleeding & unintended pregnancies, Valproic acid causes excessive sedation & lethargy, Vit D/Calcium causes osteomalacia, Irinotecan clearance increases, Folic acid decreases drug level, Corticosteroids efficacy decreases, Coumarins efficacy reduces, Alcohol increases CNS depression (drowsiness, lack of alertness & impaired co-ordination), HIV protease inhibitors increases metabolism, Clozapine/Ciclosporin/Disopyramide/Efavirenz/Felodipine/Imatinib/Lamotrigine/Nevirapine/Nifedipine/Nimodipine/Verapamil level reduces, Carbamazepine levels increases, Theophylline reduces drug level Others Ifosfamide causes encephalopathy, Cefotaxime causes exanthematous skin reactions, Metronidazole/Chloramphenicol effects reduces, Felbamate increases adverse effects (drowsiness, lethargy, anorexia, ataxia), Mebendazole/Albendazole plasma levels reduces, Quinidine serum level reduces

Diet:

Monitor: Serum drug level, mental status, CBC, LFTs, seizure activity

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