Phenobarbital For Seizures - What You Need To Know
I have an ongoing series on this blog, where I discuss various anti-seizure medications. How they work, their benefits, their downsides, and anything else I feel is relevant to mention. Eventually I want to cover every single epilepsy medication out there.
So today, the next on the list is phenobarbital…
What is phenobarbital?
Phenobarbital is actually the oldest epilepsy medication that’s still in use today, since it was developed in 1912! And essentially, this medication is meant to mimic a brain chemical called GABA.
By mimicking GABA, phenobarbital is able to calm overactive nerves within the body and raise the seizure threshold. Aside from its main use, which is to treat seizures, this medicine may also be used to treat anxiety or be used as a sedative. As it’s known to relax you.
And actually, phenobarbital is part of a family of medications called barbiturates; which are relaxants as well. But barbiturates as a whole can be quite addictive, so sometimes phenobarbital will be prescribed to help minimize withdrawals when someone is coming off of another medicine in the same family. (Although it can be addictive as well.)
Which types of epilepsy does it treat?
According to the Epilepsy Foundation, phenobarbital is used to treat the following types of seizures and epilepsies…
Seizures -
Focal impaired awareness seizures
Tonic seizures
Clonic seizures
Tonic clonic seizures
Bi-lateral tonic clonic seizures
Refractory seizures
Specific Epilepsies -
Temporal Lobe Epilepsy
Lennox-Gastaut Syndrome
Rasmussen’s Syndrome
Who shouldn’t take this medicine?
Just as some people are more likely to find success with phenobarbital, there are some people who shouldn’t take it. Such as those with…
An allergy to barbiturates
Breathing disorders like severe asthma or COPD
A history of addiction to the medication, or similar ones (Ativan, Valium, etc)
Severe liver disease
Or people with a history (family or personal) of porphyria
And similarly, if you…
Have certain food or drug allergies
Take blood thinners
Have liver disease (even if it isn’t severe)
Have a kidney disease
Deal with temporary or chronic pain
Suffer from pheochromocytoma
Or have a pituitary gland disorder…
Then you’ll need to talk to your doctor about those things as well. So they can decide whether or not it’s safe for you to try out this medication.
What are the symptoms associated with phenobarbital?
Phenobarbital can cause a variety of symptoms, ranging from mild to severe. Including…
Sleepiness or fatigue (this is the most commonly reported side effect)
Hyperactivity (occurs in children who take phenobarbital, not adults)
Inattention
Memory issues
Slurred speech
Dizziness
Depression
A lack of sexual interest (males might also be unable to form an erection)
Stomach upset, nausea, vomiting
A rash
A fever
Anemia
Folic acid deficiency
Calcium deficiency and bone loss
Pain in joints or thickening of areas like the soles of the feet are also possible over time.
And on a more severe level…
Dependency and addiction to the medication is possible, and withdrawals when weaning off of the medicine can be severe, especially if the process is not done properly. Resulting in anxiety, confusion, sweating, seizures, and even death in extremely rare cases.
Depression to the point of suicidal thoughts or actions are also possible, as with many epilepsy medications. So it’s important for even small changes in mood to be taken seriously.
Phenobarbital can also cause birth control to lose effectiveness, meaning that there’s an increased chance of getting pregnant. And if you’re pregnant whilst taking phenobarbital, there’s actually an increased risk of certain birth defects.
Finally, phenobarbital can be deadly if mixed with too much alcohol or other substances like narcotics. Making it dangerous for those with substance abuse issues.
Brands, Doses, and Cost of Phenobarbital
Now, let’s move on to some other important aspects of phenobarbital…
Brands -
Phenobarbital can be found in its generic version in many different countries. But some brand name versions include… Luminal, Solfoton, and Sezaby.
Cost -
Generic versions of phenobarbital are quite cheap, even without insurance. Costing only about $49 for 60 tablets in most cases. And with insurance, the average price (out of pocket) is only about $2 for the same amount.
It’s this low price and generic availability that makes phenobarbital one of the top contenders for providing epilepsy treatment to low/middle income countries.
Doses -
Usually, phenobarbital (regardless of brand or manufacturer) will be available in 15 mg, 30 mg, 60 mg, and 100 mg tablets. As well as 20 mg per 5 mL liquid solutions.
In terms of the doses that are usually prescribed to people, it obviously varies based on the specifics of the case. But typically the daily dose will fall somewhere in the range of 60-200 mg. And this may or may not be combined with other anti-seizure medications as well.
One important thing to note here is that phenobarbital stays in the body for quite a while, so unlike some other anti-seizure medications, it may be able to be taken only once a day and stay at a consistent level throughout the day. Once again, depending on the case.
Pros and Cons of Phenobarbital
Before we officially wrap up this post, let’s quickly go over the main pros and cons of this medicine. As I feel like it summarizes everything we’ve covered…
Benefits -
Budget Friendly - As we’ve already covered, phenobarbital is quite budget friendly. So for low income households, it could be a lifesaver for those with epilepsy. Especially if you don’t have insurance.
Comes In Multiple Forms - Because phenobarbital comes in such a variety of doses, it makes it easier to customize the dose based on someone’s needs. Rather than having to settle for a dose that’s either slightly too high or too low for your needs.
Is Effective - When used to treat the right kinds of seizures and epilepsies, phenobarbital has been shown to be very effective. Which is why it’s been on the market for so long.
Has A Long History - And speaking of its long history in treating seizures, some might see this as a pro. Since you pretty much know exactly what you’re getting.
Downsides -
Dependency - Anytime there’s an enhanced risk of addiction to a medication, that’s an automatic downside. Because you never know when you’ll need to stop taking the medication for one reason or another. Plus, it could even lead to people abusing their own medication in very severe cases.
Side Effects - Likewise, when there are a lot of side effects that come along with something, it’s another “con”. And with phenobarbital, sleepiness and drowsiness are quite common! Which could be really difficult for some people to put up with, especially depending on their lifestyle.
Interactions - Phenobarbital also interacts with a lot of different medications, and this means that either those doses or your dose of phenobarbital may need to be adjusted accordingly. And some combinations may not be able to coexist at all.
Conclusion
Many doctors no longer prescribe phenobarbital because of all the potential side effects, and the heightened risk of addiction. Instead opting for other, less addictive medications. But it’s still in use, and is particularly likely to be prescribed to young kids or infants suffering from seizures. As well as in low income countries.
So, like many anti-seizure medications, the ultimate consensus with phenobarbital is that it can be helpful for some and too risky for others! But regardless of what the case is for you, I hope you found this article informative and helpful.
Sources
As always, here’s a list of my sources… So that you can read more about the topic if you choose, and also so you can rest assured I shared only factual information throughout this post to the best of my ability!
https://www.epilepsy.com/tools-resources/seizure-medication-list/phenobarbital
https://my.clevelandclinic.org/health/drugs/18614-phenobarbital-tablets
https://www.drugs.com/mtm/phenobarbital.html
https://pubmed.ncbi.nlm.nih.gov/23205961/
https://www.webmd.com/drugs/2/drug-8689/phenobarbital-oral/details
https://www.aafp.org/pubs/afp/issues/2008/0901/p634.html
https://www.drugs.com/ingredient/phenobarbital.html
https://www.singlecare.com/blog/phenobarbital-without-insurance/
https://www.buzzrx.com/phenobarbital/pros-cons
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