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Phenobarbital

Classification

HIGH-ALERT MEDICATION

Anticonvulsant; barbiturate

Indications

PCFP: Treatment of the above conditions where advanced airway management is available.

ACFP/CCP: Treatment of refractory status epilepticus in adults and pediatrics.

ACFP/CCP: Treatment of status epilepticus in neonates.

Contraindications

Hypersensitivity to phenobarbital, barbiturates, or any component of the formulation
Severe hepatic dysfunction
Porphyria

Adult dosages

PCFP: Refractory status epilepticus where advanced airway management is available

ACFP/CCP: Refractory status epilepticus

15 mg/kg IV

PCFP: Restricted operational scope. ☎️ CCP-A consultation required to establish care plan with clinical advisory group including medical oversight
ACFP: ☎️CCP-A consultation required

Pediatric Considerations And Dosing

ACFP/CCP: Refractory status epilepticus in pediatrics

ACFP/CCP: Status epilepticus in neonates

PCFP: For all indications where advanced airway support is present

20 mg/kg (Max 1000 mg)

ACFP: CCP-A consultation required
PCFP: Restricted operational scope. CCP-A consultation required to establish care plan with clinical advisory group including medical oversight

Preparation and Administration

Adult: IV Direct

Dilute in 10mL of sterile water and give at a rate of 25 - 50mg/minute

Pediatric: IV Direct

1mg/kg/min over 20 minutes

Mechanism Of Action

Long-acting barbiturate with sedative, hypnotic, and anticonvulsant properties. Barbiturates depress the sensory cortex, decrease motor activity, alter cerebellar function, and produce drowsiness, sedation, and hypnosis. In high doses, barbiturates exhibit anticonvulsant activity; barbiturates produce dose-dependent respiratory depression.

Pharmacokinetics

IV
- Onset: 5 minutes
- Peak: 15 minutes
- Duration: - 3-4 hours

Adverse Effects

CNS: sedation, agitation, confusion, dizziness, headache
Cardiovascular: Hypotension, shock, bradycardia (especially with rapid administration
Resp: Respiratory depression, apnea, bronchospasm (especially with rapid administration)
Gastrointestinal: Nausea, vomiting
Derm/MSK: Injection site reaction, exfoliative dermatitis, skin rash, Stevens-Johnson syndrome, hyperkinesis, laryngospasm

Warning And Precautions

Hypersensitivity: Exfoliative dermatitis and Stevens-Johnson syndrome, possibly fatal, may occur; discontinue if dermatological reactions occur

Drug Interactions

Depressant effects are potentiated by the presence of other CNS depressants such as alcohol, sedatives, antihistaminics, or psychotropic drugs
Patients on neuroleptics: Opioids may increase the risk of respiratory depression, hypotension, and profound sedation or coma