Phenobarbital dosage for control of neonatal seizures

Abstract

The relationship of the initial phenobarbital dose to weight, gestational age, blood level, and seizure control was studied in 39 neonates. The blood proportional to the dosage per kilogram, and was not related to weight or gestational age. Seizures remitted only at blood phenobarbital concentrations above 16.9 micrograms per milliliter. Therapeutic levels can be achieved by the intravenous or intramuscular administration of 16 to 23 mg per kilogram of phenobarbital.

A Clinical Trial Assessing the Efficacy and Safety of a New Injectable Formula of Sodium Phenobarbital Containing No Additives for the Treatment of Neonatal Seizures

“…／ After the loading dose of 20 mg／kg, plasma phenobarbital concentration rapidly reached the ／ therapeutic range of 20 to 25 mg／mL. These levels were consistent with previous reported data 9,10) . The ／ maintenance phenobarbital therapy at 2.5 to 5 mg／ ／ kg／day also resulted in stable and sustained therapeutic plasma drug concentrations.…”

A randomized controlled trial on comparison of phenobarbitone and levetiracetam for the treatment of neonatal seizures: pilot study

“…Though there is agreement regarding the battery of diagnostic tests, the most appropriate anticonvulsant is still debatable. [1][2][3][4] Perinatal asphyxia is the commonest cause of neonatal seizure worldwide. Phenobarbitone is the most commonly used drug for treatment of neonatal seizures, irrespective of the cause of the seizures.…”

Phenobarbital for Treatment of Seizures in Preterm Infant: A New Administration Scheme

“…The maintenance of therapeutic serum concentrations at 12, 24, and 36 h is due to the long half-life of this drug in neonates [8,[12][13][14]17], In fact, during the first 2 weeks of life, the half-life of phénobarbital is pro longed by a reduced renal clearance and by the immaturity of liver functions [14,16,19]. Nevertheless, in infants with a lower gestational age phénobarbital levels after loading decreased more rapidly than in neo nates with a greater gestational age, this may be due to a greater volume of distribution of the drug [11][12][13][14][15][16][17][18][19][20], to lower serum protein concentrations and a greater distribution to tissues [13,14], During intramuscular maintenance, the liver immaturity and the reduced renal clear ance became more evident: babies in group I showed significantly higher phénobarbital plasma levels than those in group II.…”

“…After the 2nd week of life, in the absence of a gastrointestinal pa thology, the oral absorption was rapid and effective [9,15], A proposed therapeutic scheme with intramuscular maintenance given at 36 h allowed us to avoid the over dosage observed when the maintenance was established before 36 h [17][18][19]21] or ad ministered intravenously [16], Three infants with a gestational age of < 28 weeks showed higher phénobarbital levels (30-40 pg/ml), A close correlation between the CSF/ blood ratio and the time of treatment was also observed. In fact in asphyxiated neo nates a ratio of 0.58 ± 0.16 was found 30 min after the intravenous loading dose, while a few days after the beginning of treat ment the ratio increased to 0.90 ± 0.12.…”