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[Plasma concentrations of phenobarbital and dosage according to age]
Insights
Intravenous phenobarbital rapidly achieves therapeutic levels, making it ideal for intensive care. Oral administration delays effectiveness, and specific dosages are recommended for children versus adults.
Area of Science:
- Pharmacology
- Clinical Pharmacy
- Pediatric Neurology
Context:
- Phenobarbital is a common first-line treatment for various conditions.
- Optimizing phenobarbital dosing is crucial for efficacy and safety.
- Previous studies have explored different administration routes and dosages.
Purpose:
- To evaluate the efficacy and optimal dosing of phenobarbital based on administration route and patient age.
- To compare the speed of achieving therapeutic plasma concentrations between oral and intravenous phenobarbital.
- To determine appropriate loading and maintenance doses for different age groups, including infants, children, and adults.
Summary:
- Phenobarbital was administered to 198 subjects (136 infants, 62 adults) via oral or intravenous routes with age-adjusted loading doses and a 5 mg/kg daily maintenance dose.
- Intravenous administration achieved therapeutic plasma concentrations more rapidly than oral administration, supporting its use in intensive care settings.
- A 20 mg/kg intravenous dose was found adequate for children up to 15 years, while 15 mg/kg was considered too high for adults. Oral administration delayed peak efficacy up to 12 hours.
Impact:
- Recommends intravenous phenobarbital for rapid therapeutic effect, particularly in intensive care.
- Provides specific intravenous posology guidelines for children and adults.
- Highlights the delayed efficacy of oral phenobarbital and suggests varied adequate posologies for infants, excluding premature newborns.
Abstract:
Phenobarbital was used as first treatment in 198 subjects with different loading doses adjusted according to age, followed by a daily maintenance dose of 5 mg/kg. A loading dose was given per os to 136 infants in four groups and intravenously to 62 subjects in five groups (including 30 adults). We found that the intravenous route must be used for the rapid production of therapeutic plasma concentrations and accordingly we recommend it in intensive care. Posology of 20 mg/kg i.v. appears to be adequate in children up to 15 years old while a posology of 15 mg/kg seems to be too high in adults. The maximum probability of efficiency is delayed up to 12 h when phenobarbital is given per os. Various posologies were found to be adequate in infants except for premature newborns.