Neonatal Drug Therapy Manual

PHENobarbital

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Updated June 22, 2022 - 11:00am

Classification: 
Anticonvulsant
Original Date: 
March 1992
Revised Date: 
June 2022
Indications: 
  • Treatment of neonatal seizures
  • Treatment of neonatal abstinence syndrome (NAS) in combination with morphine
Administration: 
  • IV Direct: rate not to exceed 1 mg/kg/min
  • IV intermittent infusion: infuse over > 20 minutes.  Do not exceed 1 mg/kg/minute.
  • PO
Dosage: 

Treatment of neonatal seizures

  • Load: 10 mg/kg IV for infrequent seizures
    • 20 mg/kg IV for frequent or continuous seizures
    • Give an additional 10 mg/kg IV for recurrent seizures up to a total load of 40 mg/kg
  • Maintenance: IV/PO: 3-5 mg/kg/day divided BID

 

Treatment of neonatal abstinence syndrome

  • 10 mg/kg/dose PO Q12h for 3 doses, then 5 mg/kg/day.
Side Effects: 
  • CNS: drowsiness
  • CVS: hypotension, bradycardia
  • Local: injection site reactions
  • Respiratory: respiratory depression, apnea
Parameters to Monitor: 
  • BP, HR, RR
  • Therapeutic serum levels: (65-170 umol/L)
    • Usual sampling time:
      • During acute phase: no restrictions but at least 1 hour since last dose
      • During Maintenance: trough level (0 - 60 minutes before next dose)
Reconstitution and Stability: 

IV Direct / IV intermittent infusion:

Doses < 30 mg:

  • Phenobarbital 30 mg/mL
    • Take 1 mL (30 mg) and add to 5 mL of 0.9% NaCl
    • Final concentration: 5 mg/mL

Doses >30 mg to 60 mg:

  • Phenobarbital 30 mg/mL
    • Take 2 mL (60 mg) and add to 10 mL of 0.9% NaCl
    • Final concentration: 5 mg/mL
  • Doses > 60 mg:
    • Phenobarbital 30 mg/mL
      • Take 3 mL (90 mg) and add to 15 mL of 0.9% NaCl
      • Final concentration: 5 mg/mL
Compatibility: 

- Solutions Compatible: dextrose, 0.9% NaCl, dextrose-saline combinations

- Y-site Compatible: aminophylline, heparin, morphine, vancomycin

Incompatible : TPN

References: 

- van Rooij LGM, et al., Treatment of neonatal seizures. Seminars in Fetal & Neonatal Medicine (2013), http://dx.doi.org/10.1016/j.siny.2013.01.001

- Moore Hepburn C, Booth M. Ontario's Provincial Council for Maternal and Child Health.  Healthcare Quaterly Vol.15. Special Issue. July2012

- Trissel LA.  Handbook on Injectable Drugs. 16th Edition.  Bethesda: American Society of Health-System Pharmacists; 2011

 

 

The information contained on this website is provided for informational purposes only, as a guide to assist physicians, nurses and other healthcare providers in deciding on the appropriate care required for a particular patient. At all times, physicians, nurses and other healthcare providers must exercise their independent clinical judgment, based on their knowledge, training and experience, taking into account the specific facts and circumstances of each patient, when deciding on the appropriate course of investigation and/or treatment to recommend in a particular clinical situation.

CHEO has made every effort to ensure that the information contained on this website is as current and accurate as possible. However, changes can occur due to ongoing research and the constant influx of new information. Where possible, hospitals and healthcare practitioners should verify the information before acting on it.

Reliance on any information in this website is at the user's own risk. CHEO is not responsible or liable for any harm, loss or other consequences from the use or misuse of the information on this website.