Can I Buy Phenobarbital Online
If you suddenly stop using this medication, you may have withdrawal symptoms (such as anxiety, hallucinations, twitching, trouble sleeping). Withdrawal from phenobarbital can be severe and include seizures and (rarely) death. To help prevent withdrawal, your doctor may lower your dose slowly. Withdrawal is more likely if you have used phenobarbital for a long time or in high doses. Tell your doctor or pharmacist right away if you have withdrawal.
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In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345. Precautions Before taking phenobarbital, tell your doctor or pharmacist if you are allergic to it; or to other barbiturates (such as primidone, secobarbital); or to other anti-seizure medications (such as carbamazepine, fosphenytoin, oxcarbazepine, phenytoin); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
Phenobarbital is very similar to primidone. Do not use medications containing primidone while using phenobarbital. Does Phenobarbital interact with other drugs you are taking? Enter your medication into the WebMD interaction checker Check Interaction Overdose If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe tiredness/dizziness, inability to wake up, very slow breathing rate. Notes Do not share this medication with others. Sharing it is against the law.
For long-term use, lab and/or medical tests (such as phenobarbital blood levels, blood counts, liver/kidney function) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details. Missed Dose If you are taking this medication to prevent seizures and miss a dose, take it as soon as you remember unless it is almost time for the next dose. In that case, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up. Storage Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.
Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company. Images phenobarbital 100 mg tablet
At Genius General hospital, we have been using phenobarbital monotherapy for alcohol withdrawal increasingly since 2014. Our experience has been quite positive. Per my (admittedly biased) recollections:
This is a retrospective cohort study describing 86 admissions to the ICU for alcohol withdrawal between 2011-2015.2 86% were treated with benzodiazepines before ICU admission, usually on the general ward. The average dose of benzodiazepine before ICU admission was equivalent to 23 mg of lorazepam. Following ICU admission, all benzodiazepines were discontinued and patients were treated solely with IV phenobarbital. Doses of 130 mg IV were given every 15 minutes in a symptom-triggered fashion to target a Richmond Agitation and Sedation Scale (RASS) of 0 to -1:
The greatest strength of their protocol was the use of frequent (q15 minutes) and relatively small (130 mg) intravenous doses of phenobarbital. Most prior studies have used less frequent dosing of phenobarbital (e.g. q30 min or q60 min) to allow for assessment of the effect of one dose before giving the next dose. However, IV phenobarbital distributes rapidly, so a 15 minute dosing interval is arguably ideal. Using a short dosing interval allows for relatively small doses to be given successively, facilitating precise titration to effect.
This protocol generally worked extremely well. However, we did encounter one patient who received an excessive dose of phenobarbital (the patient did fine, but upon retrospective review his phenobarbital dose and levels were excessive). The problem with the above protocol is that if the patient develops another cause of agitation besides alcohol withdrawal, the patient may wind up receiving enormous doses of phenobarbital. The crux of the matter is as follows:
The protocol was consequently modified as shown below, with greater attention to the cumulative phenobarbital dosing. After the patient has received a relatively large cumulative dose of phenobarbital (30 mg/kg), additional phenobarbital is generally curtailed. At this point it is assumed that the patient has received sufficient treatment for alcohol withdrawal. Any residual delirium beyond this point is unlikely to be related to alcohol withdrawal, so it may be more appropriately treated with an antipsychotic. This issue has been previously discussed on the blog in more detail (see: Pitfall #1 Looping Paradox.)
Below is my updated guideline to phenobarbital dosing, based on this new data. Phenobarbital titration has been changed to 130 mg IV q15 minutes with a RASS target. Although a variety of dosing strategies are possible, currently this strategy is most strongly supported for phenobarbital monotherapy within a critical care context.
Nonetheless, these observational data are impressive (particularly the low intubation rate). I suspect that this largely reflects the underlying strength of phenobarbital as an agent for alcohol withdrawal. At the least, it unequivocally demonstrates that phenobarbital monotherapy can be safe and effective.
A 38-year-old man was admitted to the ICU following intubation for status epilepticus in the context of alcohol withdrawal. He received several doses of phenobarbital with the dual intention of seizure control and treatment of alcohol withdrawal. In total, he received 20 mg/kg phenobarbital, which pushed his serum phenobarbital level to 22 ug/ml (this is incidentally at the lower end of the therapeutic range for epilepsy, 15-40 ug/mL). While he received these dose increments, he remained agitated. Extubation was initially delayed due to atelectasis. When he was finally deemed ready for extubation based on respiratory parameters, he was unexpectedly found to be somnolent. He had developed hepatic encephalopathy during his ICU course, which may have synergized with phenobarbital to cause somnolence. He tolerated extubation and was treated for hepatic encephalopathy, with improvement. However, his somnolence nearly precluded extubation and thereby threatened to prolong his intubation.
As explored previously, the pharmacokinetics of phenobarbital are extremely predictable. This allows us to give 10-30 mg/kg phenobarbital to anyone, with confidence that this will not cause a toxic phenobarbital level (>40 ug/mL). However, in patients with a very tenuous mental status for another reason (e.g. hepatic encephalopathy), it is possible that even a therapeutic phenobarbital level could compromise mental status.
Phenobarbital comes as a tablet and an elixir (liquid) to take by mouth. It is usually taken one to three times a day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take phenobarbital exactly as directed.
Do not stop taking phenobarbital without talking to your doctor. If you suddenly stop taking phenobarbital, you may experience withdrawal symptoms such as anxiety, muscle twitching, uncontrollable shaking of a part of the body, weakness, dizziness, changes in vision, nausea, vomiting, seizures, confusion,difficulty falling asleep or staying asleep, or dizziness or fainting when getting up from a lying position. Your doctor will probably decrease your dose gradually.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online ( ) or by phone (1-800-332-1088).
In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.
Barbiturates are a class of sedative-hypnotic drugs. They are commonly used as antiepileptics (phenobarbital) and for the induction of general anesthesia (thiopental). This activity illustrates the evaluation and management of barbiturate toxicity and reviews the role of the interprofessional team in improving care for patients with this condition.
Barbiturates are a class of sedative-hypnotic drugs. They are commonly used as antiepileptics (phenobarbital) and for the induction of general anesthesia (thiopental). Some states administer barbiturates for physician-assisted suicide/euthanasia and use them for capital punishment by lethal injection. Their use in clinical practice has largely been replaced by benzodiazepines such as alprazolam, diazepam, and lorazepam due to the lower risk of overdose and available antidote to reverse toxicity. Barbiturates are used as a laboratory buffer and can be found in clinical and research laboratories.[1][2]
Barbiturates have various onsets of action, durations, half-lives, and toxic levels, depending on the lipid solubility and rate of metabolic inactivation. The onset of action for oral administration ranges from 20 to 60 minutes, and intravenous administration can range from almost immediate to 5 minutes. High lipid-solubility in some (amobarbital, pentobarbital, and thiopental) allow them to be well absorbed and rapidly redistributed. Most are rapidly metabolized to inactive compounds before they are excreted in the urine. However, phenobarbital is only partially converted and can be found unchanged in the urine. Phenobarbital is a long-acting, polar drug that is slowly absorbed and slowly redistributed, contributing to its longer duration of action. Barbiturates easily cross the placenta and are excreted into breast milk. 041b061a72