Can we safely administer the recommended dose of phenobarbital in very low birth weight infants?

Öztekin, Osman; Kalay, Salih; Tezel, Gönül; Akçakuş, Mustafa; Oygür, Nihal

doi:10.1007/s00381-013-2094-8

Cited by 12 publications

(7 citation statements)

References 13 publications

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“…The elimination half-life of PHB is in the wide range of 30-173 h (Table 1). Therapeutic levels in human plasma are proposed to be in the range of 10 ( 15)-40 mg/L [50][51][52]. Interactions of PHB are results of the inducing effect of PHB on CYP1A2, CYP3A, 4CYP3A6, CYP2B, CYP2C9, CYP2C19 and UTGs [69,75].…”

Section: Phenobarbitalmentioning

confidence: 99%

Pharmacokinetic Drug–Drug Interactions among Antiepileptic Drugs, Including CBD, Drugs Used to Treat COVID-19 and Nutrients

Karaźniewicz−Łada

Główka

Mikulska

et al. 2021

IJMS

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Anti-epileptic drugs (AEDs) are an important group of drugs of several generations, ranging from the oldest phenobarbital (1912) to the most recent cenobamate (2019). Cannabidiol (CBD) is increasingly used to treat epilepsy. The outbreak of the SARS-CoV-2 pandemic in 2019 created new challenges in the effective treatment of epilepsy in COVID-19 patients. The purpose of this review is to present data from the last few years on drug–drug interactions among of AEDs, as well as AEDs with other drugs, nutrients and food. Literature data was collected mainly in PubMed, as well as google base. The most important pharmacokinetic parameters of the chosen 29 AEDs, mechanism of action and clinical application, as well as their biotransformation, are presented. We pay a special attention to the new potential interactions of the applied first-generation AEDs (carbamazepine, oxcarbazepine, phenytoin, phenobarbital and primidone), on decreased concentration of some medications (atazanavir and remdesivir), or their compositions (darunavir/cobicistat and lopinavir/ritonavir) used in the treatment of COVID-19 patients. CBD interactions with AEDs are clearly defined. In addition, nutrients, as well as diet, cause changes in pharmacokinetics of some AEDs. The understanding of the pharmacokinetic interactions of the AEDs seems to be important in effective management of epilepsy.

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Section: Phenobarbitalmentioning

confidence: 99%

Pharmacokinetic Drug–Drug Interactions among Antiepileptic Drugs, Including CBD, Drugs Used to Treat COVID-19 and Nutrients

Karaźniewicz−Łada

Główka

Mikulska

et al. 2021

IJMS

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“…Jalling states the approximate range of phenobarbital concentration when convulsions ceased was 12‐30 mg/L (52‐129 μmol/L) . Some studies targeted at range of 10‐30 mg/L (43‐129 μmol/L)and others 15‐40 mg/L (65‐172 μmol/L) . Based on these data, phenobarbital levels between 10 and 40 mg/L (43‐172 μmol/L) can be considered likely to be effective.…”

Section: What Is Known and Objectivementioning

confidence: 99%

“…2 Some studies targeted at range of 10-30 mg/L (43-129 μmol/L)and 3,4 others 15-40 mg/L (65-172 μmol/L). [5][6][7][8] Based on these data, phenobarbital levels between 10 and 40 mg/L (43-172 μmol/L) can be considered likely to be effective. Routine therapeutic drug monitoring (TDM) is recommended during phenobarbital treatment to maximize efficacy and safety.…”

Section: What Is Known and Objectivementioning

confidence: 99%

Estimation of initial phenobarbital dosing in term neonates with moderate‐to‐severe hypoxic ischaemic encephalopathy following perinatal asphyxia

et al. 2017

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“…Furthermore the safety of loading dose administration in low birth weight and preterm neonates has been questioned, with currently recommended doses leading to higher than anticipated drug levels (11). …”

Section: Introductionmentioning

confidence: 99%

Phenobarbital and neonatal seizures affect cerebral oxygen metabolism: a near-infrared spectroscopy study

et al. 2015

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Background Near-infrared spectroscopy (NIRS) measures oxygen metabolism and is increasingly used for monitoring critically-ill neonates. The implications of NIRS-recorded data in this population are poorly understood. We evaluated NIRS monitoring for neonates with seizures. Methods In neonates monitored with video-EEG, NIRS-measured cerebral regional oxygen saturation (rSO2) and systemic O2 saturation were recorded every 5 seconds. Mean rSO2 was extracted for 1-hour blocks before, during, and after phenobarbital doses. For each electrographic seizure, mean rSO2 was extracted for a period of 3-times the duration of the seizure before and after the ictal pattern, and during the seizure. Linear mixed models were developed to assess the impact of phenobarbital administration and of seizures on rSO2 and fractional tissue oxygen extraction (FTOE). Results For 20 neonates (EGA 39.6±1.5 weeks), 61 phenobarbital doses and 40 seizures were analyzed. Cerebral rSO2 rose (p=0.005), and FTOE declined (p=0.018) with increasing phenobarbital doses. rSO2 declined during seizures, compared with baseline and post-ictal phases (baseline 81.2 vs. ictal 77.7 vs. post-ictal 79.4; p=0.004). FTOE was highest during seizures (p=0.002). Conclusions Cerebral oxygen metabolism decreases after phenobarbital administration and increases during seizures. These small, but clear, changes in cerebral oxygen metabolism merit assessment for potential clinical impact.

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Can we safely administer the recommended dose of phenobarbital in very low birth weight infants?

Abstract: We suggest that particular attention should be done while administering phenobarbital in preterms, as blood levels of phenobarbital are higher than the reference ranges that those are often reached with the recommended doses in these groups of babies.

Cited by 12 publications

References 13 publications

Pharmacokinetic Drug–Drug Interactions among Antiepileptic Drugs, Including CBD, Drugs Used to Treat COVID-19 and Nutrients

Pharmacokinetic Drug–Drug Interactions among Antiepileptic Drugs, Including CBD, Drugs Used to Treat COVID-19 and Nutrients

Estimation of initial phenobarbital dosing in term neonates with moderate‐to‐severe hypoxic ischaemic encephalopathy following perinatal asphyxia

Phenobarbital and neonatal seizures affect cerebral oxygen metabolism: a near-infrared spectroscopy study

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