Clinical beta
FMBM is currently in clinical beta. Content is for professional review/testing and must not replace local protocols, senior clinical judgment, or official prescribing references.
Drug Monograph
USE IF: Seizure control (including status pathways), adjunct in refractory seizures, and selected sedation protocols with monitored settings.
AVOID IF: Severe respiratory depression, hemodynamic instability without monitoring, porphyria, or significant hypersensitivity to barbiturates.
Phenobarbital
Barbiturate antiepileptic / sedative-hypnotic
Indication
Seizures • Status epilepticus (adjunct/refractory) • Sedation (selected ICU contexts)
INDICATIONS (CORE USE)
- Seizures (focal/generalized) - Status epilepticus (adjunct or refractory pathway) - Sedation (selected ICU protocol use only)
ADULT DOSE (STANDARD)
Seizures: individualized; loading often required in acute settings Status epilepticus (adjunct): IV loading per protocol -> maintenance dosing Sedation: protocol-based only
MAX DOSE
Protocol-dependent; avoid excessive accumulation due to long half-life
Route
PO / IV / IM
PEDIATRIC DOSE
Specialist/protocol-based
Must-not-miss safety points
Major warning
- Respiratory depression -> airway risk - Profound sedation/coma at high doses - Hypotension (especially with IV loading) - Strong enzyme induction -> major drug interaction burden - Withdrawal can precipitate seizures (do not stop abruptly)
Primary
Secondary
STANDARD (ADULT PO)
Load in acute seizure settings -> maintenance dosing based on response and levels Titrate cautiously due to long half-life
ADULT DOSE
Adult dosing is protocol-based and individualized by indication, route, and monitoring context. In acute care, loading is commonly followed by maintenance dosing with reassessment of sedation, respiratory status, and seizure control.
PEDIATRIC DOSE
Protocol-based specialist dosing.
MAX DOSE
Protocol-dependent; avoid repeated aggressive escalation because accumulation is delayed and prolonged.
Practical Note
- Long half-life -> accumulation risk - Dose adjustments require time; avoid rapid repeated escalation - Therapeutic drug monitoring may be required
Clinical warnings
Pediatrics
Specialist/protocol-based
Pregnancy
Pregnancy/
Lactation
risk-benefit assessment with specialist guidance; prioritize maternal stabilization and seizure control when clinically indicated.
Renal impairment
Monitor for accumulation and clinical toxicity.
Hepatic impairment
Use caution; metabolism is hepatic and effect may be prolonged.
Elderly
Increased sensitivity to sedation, confusion, and falls.
- IV: administer slowly to reduce hypotension and respiratory depression - Avoid rapid bolus unless protocolized emergency use - PO is commonly used for maintenance
Clinical Picture
CNS depression to coma, respiratory depression, and hypotension.
Immediate Actions
Prioritize airway support, provide ventilatory support when needed, and stabilize hemodynamics.
Antidote
No specific antidote; management is supportive.
Decontamination
Consider decontamination only in selected early ingestions with protected airway and toxicology guidance.
Escalation
Escalate to ICU for ongoing respiratory/circulatory support and close neurologic monitoring.
Common mistakes, resistance logic, and bedside traps
Pharmacy Tool
solution · oral
Pharmacist verification beta
Preparation formulas are currently in pharmacist verification beta and must be validated against institutional protocols before use. Additional safeguards apply (narrow therapeutic index).
Acknowledge the statements above to unlock volume scaling and ingredient quantities.
- Long half-life (very prolonged) - Hepatic metabolism - Strong enzyme inducer
- Enhances GABA-mediated CNS inhibition
Saudi Arabia
Luminal, Phenobarbital
Global
Luminal (example), Phenobarbital (generic)
Common trade names are curated examples only — formulations and availability vary. Verify the exact product name with your local pharmacy and national regulator before prescribing or dispensing.
Global data (no country-specific data available)
Saudi Arabia
International