Phenobarbitone
At a Glance
Why Get Tested?
To determine if the phenobarbitone level in the blood is at a therapeutic level for an individual patient
When to Get Tested?
At regular intervals to monitor phenobarbitone level in the blood and as needed to detect low or toxic
Sample Required?
A blood sample drawn from a vein in your arm
The Test Sample
What is being tested?
This test measures the level of phenobarbitone in the blood. Phenobarbitone is a barbiturate, a highly addictive, sedating drug that depresses the nervous system. Doctors usually prescribe phenobarbitone to prevent seizures or to relieve anxiety. Phenobarbitone is often prescribed to treat epilepsy and other seizure disorders because the drug stabilises electrical activity in the brain.
Your doctor will monitor your response to phenobarbitone to make sure that you have the desired level of the drug in your bloodstream and to determine the dose that works best for you. Monitoring also helps assure your doctor that the level of the drug circulating in your bloodstream is not toxic. Your doctor might order a phenobarbitone level when you begin taking the drug, and any time while on the medication, to determine if the dose is right for you. Your doctor might also decide to order a test if you begin taking another medication because several common drugs can affect how your body responds to phenobarbitone. The following drugs can have effects with phenobarbitone:
- oral anticoagulant medications like warfarin
- antidepressants and tricyclics, including MAO inhibitor antidepressants
- central nervous system depressants, sedatives, hypnotics and tranquilisers
- antihistamines
- alcohol
- oral contraceptives
- corticosteroids like prednisone
- doxycycline used to treat bacterial infections
- griseofulvin, a drug used to treat fungal infections
- phenytoin, another medication often prescribed to treat seizures.
It’s important for you to maintain a constant level of phenobarbitone in the blood within the therapeutic range. If your level is too low, you may experience seizures or anxiety. If the level is too high, you could experience side effects or even toxicity.
But maintaining a constant, therapeutic level of phenobarbitone in the blood can be tricky. Phenobarbitone is metabolised by liver enzymes and eliminated in the urine at different rates, depending on your age and overall health. Depending on dose, age and health, elimination can take several days to weeks. Once the body has reached its capacity to metabolise phenobarbitone, small increases in dose can result in large increases in levels of the drug in the blood. Side effects can become more severe, and toxicity may occur.
How is the sample collected for testing?
A blood sample is collected by inserting a needle into a vein in the arm.
Is any test preparation needed to ensure the quality of the sample?
No test preparation is needed.
The Test
How is it used?
A doctor orders the test to measure and monitor the amount of phenobarbitone in the blood and to determine whether the drug level is within a therapeutic range. A doctor may order the test every few weeks when you first begin taking the drug to help adjust the dose so that you have the desired level in your blood. Afterwards, the doctor will probably order the test at regular intervals. If you begin taking another medication, your doctor will likely order more monitoring because phenobarbitone interacts with several other common drugs. Phenobarbitone might increase or decrease a specific drug’s effectiveness, and that medication may also affect the level of phenobarbitone in the blood. The result could be decreased effectiveness from too low a level or severe side effects/toxicity if the level is too high.
When is it requested?
A doctor will usually order the test after you start phenobarbitone treatment and if you begin taking or discontinue another medication that affects phenobarbitone levels. Once you have a stable blood level of phenobarbitone in the therapeutic range, then your doctor will monitor levels at regular intervals to ensure the levels are stable.
A doctor might also order phenobarbitone levels if you do not appear to be responding to ensure that you are taking the drug as directed or when you experience side effects or toxicity.
Minor side effects from phenobarbitone may include:
- drowsiness
- headache
- dizziness
- depression
- excitement (especially in children)
- upset stomach
- vomiting.
Tell your doctor if any of these symptoms are severe or do not go away:
- nightmares
- increased dreaming
- constipation
- joint or muscle pain.
If you experience any of the following symptoms, call your doctor immediately:
What does the test result mean?
The therapeutic range for adults taking phenobarbitone is 65-170 μmol/L (15-40 mg/L). Within this range, most people will respond to the drug without displaying symptoms of toxicity. However, each patient’s response to the drug and side effects is individual. You may experience side effects even with blood levels at the low end of the therapeutic range or continue to have seizures at the upper end. As with other antiepileptic drugs, your doctor will work with you to find the dosage that works best for you.
You should take phenobarbitone exactly as your doctor has prescribed it. Do not decrease the dose, increase it, or discontinue the medication on your own because doing so can increase your risk of having a seizure and can affect the levels of your other medications. Always consult your doctor if you are having problems taking phenobarbitone.
Is there anything else I should know?
Phenobarbitone has been used to treat epilepsy since the early 20th century and is still the most widely prescribed antiepileptic drug worldwide despite development of several others since then. Because the drug causes sedation and other side effects, it is now often a second or third line medication in developed countries. But phenobarbitone is still a first-line drug in many developing nations.
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