Phenobarbital
Status epilepticus (third-line), Refractory seizures, Alcohol withdrawal seizures
Indications
- Status epilepticus (third-line)
- Refractory seizures
- Alcohol withdrawal seizures
Adult dosing
- status epilepticus: dose: 20; unit: mg/kg; route: IV at max 60mg/min; weightBased: true; maxDose: 3000; maxDoseAbsolute: true
Pediatric dosing
- status epilepticus: dose: 20; unit: mg/kg; route: IV at max 1mg/kg/min; weightBased: true; maxDose: 1000; maxDoseAbsolute: true; pedNote: Initial loading dose; max infusion rate 1mg/kg/min
Contraindications
- Severe respiratory depression
- Porphyria
Clinical pearls
- Third-line agent — causes significant sedation and respiratory depression
- Have airway equipment and vasopressors at bedside before infusing
- Strongly consider intubation if using after benzodiazepines
- Long half-life (53-118 hours) — effects persist long after infusion
Source and review
- AES Guidelines 2016; Neurocritical Care Society. Last reviewed: 2024-11-01