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One of the oldest drugs used in epilepsy treatment -phenobarbital, introduced
in 1912.
Phenobarbital can be used to treat both partial and
generalized seizures. It also is used as part of the protocol after phenytoin use in
status epilepticus as well as in neonatal epilepsy. It is available in oral and
intravenous forms.
Phenobarbital levels need to be monitored. The recommended therapeutic level is
15-40mg/L. A complete blood analysis also should be routinely conducted. Phenobarbital can
cause changes in the metabolism of other drugs through its actions on liver enzymes. Side
effects may include drowsiness, cognitive impairment, and irritability.
In patients with partial epilepsy, large studies have consistently demonstrated similar
efficacy for phenytoin, carbamazepine, valproate, primidone (Mysoline) and phenobarbital,
although the barbiturates are often poorly tolerated as a result of their sedating
properties. The medication has been linked to decreased IQ in children born to mothers
taking this medication. Its only advantage is that it is one time daily and less expensive
than other medications.
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