phenobarbital

phenobarbital is evaluated for the following indications with varying evidence strength: Status epilepticus (evidence tier A), Neonatal seizures (evidence tier A), Focal epilepsy (evidence tier B). See the full indication matrix with dosing and citations above on this page.

Common side effects of phenobarbital (≥ 1 in 100): Sedation, drowsiness, fatigue, Incoordination, dizziness, Cognitive impairment, especially in children and elderly, Paradoxical excitement in children, Depressed mood. See the Safety section for uncommon and serious reactions.

FDA category D. FDA category D. First-trimester use carries risks of cleft palate, cardiac defects, and digital hypoplasia; third-trimester use of hemorrhagic disease of the newborn and neonatal withdrawal. Women of reproductive age are switched to safer antiepileptics (levetiracetam, lamotrigine). If therapy continues, give folic acid 4–5 mg/day and vitamin K1 (phytomenadione) to the mother in the last month and to the newborn after birth.

Passes into breast milk at 36–100% of maternal plasma level. LactMed advises caution and infant monitoring (sedation, poor feeding). Breastfeeding may need to be limited if infant develops significant symptoms.

phenobarbital is contraindicated in: Hypersensitivity to barbiturates; Severe respiratory insufficiency; Severe hepatic impairment; Acute intermittent porphyria; History of substance use disorder. Full list in the Safety section.

regular Corvalol, Valocordin, and similar products cause physical phenobarbital dependence. Withdrawal causes anxiety, insomnia, seizures. Additionally, bromide accumulates with bromism (mental disturbances, dermatitis, tremor). For cardiac symptoms, see a cardiologist, not Corvalol.

remains first-line for neonatal seizures. Included in WHO Essential Medicines List.

phenobarbital and bromide impair concentration and reaction time for 24–48 hours; with regular use this effect is constant.