ADVOCATE PHARMACY

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Description:

Phenobarbital is used alone or with other medications to control seizures. Controlling and reducing seizures lets you do more of your normal daily activities, reduces your risk of harm when you lose consciousness, and lessens your risk for a possibly life-threatening condition of frequent, repeated seizures. Phenobarbital belongs to a class of drugs known as barbiturate anticonvulsants/hypnotics. It works by controlling the abnormal electrical activity in the brain that occurs during a seizure. Phenobarbital is also used for a short time (usually no more than 2 weeks) to help calm you or help you sleep during periods of anxiety. It works by affecting certain parts of the brain to cause calming.

DOSAGES OF PHENOBARBITAL

Dosage Forms and Strengths

Tablet: Schedule IV

15 mg
16 mg
30 mg
32 mg
60 mg
64.8 mg
65 mg
100 mg

Elixir: Schedule IV

20 mg/5mL

Injectable solution: Schedule IV

30 mg/mL
60 mg/mL
65 mg/mL
130 mg/mL

Dosage Considerations – Should be Given as Follows:

Status Epilepticus

Typically used after benzodiazepines and phenytoin fail to abort status epilepticus
Adult: 15-18 mg/kg intravenous (IV) loading dose infused at 25-60 mg/min; prepare to support ventilation; may repeat in 20-minute intervals as needed; not to exceed 30 mg/kg
Infants and children: 15-20 mg/kg IV infused at a rate not to exceed 2 mg/kg/min; not to exceed 1000 mg/dose
Children under 60 kg: IV rate at less than 30 mg/min
May repeat with 5-10 mg/kg bolus dose after 15-30 min as needed; not to exceed cumulative dose of 40 mg/kg

Seizures

All types of seizure disorders, including partial, tonic-clonic, and myoclonic seizures
Adult: 1-3 mg/kg/day oral/intravenous (IV) in 1-2 divided doses initially; adjust accordingly to maintain within therapeutic serum concentration range
Neonates (less than 28 days): 3-5 mg/kg/day intravenously (IV)/orally in 1-2 divided doses
Infants: 5-6 mg/kg/day intravenously (IV)/orally in 1-2 divided doses
Children 1-5 years: 6-8 mg/kg/day intravenously (IV)/orally in 1-2 divided doses
Children 6-12 years: 4-6 mg/kg/day intravenously (IV)/orally in 1-2 divided doses
Children over 12 years: 1-3 mg/kg/day intravenously (IV)/orally in 1-2 divided doses, OR 50-100 mg two or three times daily

Sedation

Adult: 30-120 mg/day orally divided two or three times daily; do not exceed 400 mg/day
Pediatric: 2 mg/kg orally three times daily

Hypnotic

Adult: 100-320 mg/day orally/intravenously/intramuscularly; do not administer for more than 2 weeks
Pediatric: 3-5 mg/kg orally at bedtime

Insomnia

100-200 mg orally at bedtime; do not exceed 400 mg/day

Preoperative Sedation, Pediatric

1-3 mg/kg orally/intravenously/intramuscularly 1-1.5 hours before procedure

Hyperbilirubinemia (Off-label), Pediatric

Neonates: 5 mg/kg/day orally/intravenously (IV) once/day, OR divided every 12 hours for 3-6 days following birth
Children under 12 years (chronic cholestasis): 1.5-4 mg/kg orally every 12 hours

Dosing Considerations

Antiepileptic therapeutic concentration range: 10-40 mcg/L (43-172 micromoles/L)
Long half-life permits once-daily dosing, if tolerated, for seizures; single daily dosing at bedtime recommended because of sedation
Children under 6 years: Potential toxic dose 8 mg/kg
Pediatric: Antiepileptic therapeutic concentration range: 15-30 mcg/L (43-129 micromoles/L)