Infants phenobarbital

Most drugs are administered to infants and children for the same therapeutic indications as for adults. However, a few drugs have found unique uses in children. Among these are theophylline and caffeine, which are used to treat apnea of prematurity indomethacin, which closes a patent ductus arteriosus and prostaglandin Ej, which maintains the patency of the ductus arteriosus. Paradoxically, drugs such as phenobarbital, which have a sedating action on adults, may produce hyperactivity in children, and some adult stimulant drugs, such as methyl-phenidate, are used to treat children with hyperactivity. 

Aside from the bromides, phenobarbital is the oldest of the currently available antiseizure drugs. Although it has long been considered one of the safest of the antiseizure agents, the use of other medications with lesser sedative effects has been urged. Many consider the barbiturates the drugs of choice for seizures only in infants. 

Phenobarbital Moderate Hypnotic doses can cause sedation in the infant. 

Barbiturates are also used in infantile seizures that are not considered epilepsy. These seizures generally occur when an infant has a high fever, and therefore they are called febrile seizures. Phenobarbital is still commonly used to prevent seizures in infants, because scientists do not routinely study new drugs in infants and children. Because phenobarbital is... 

By 12 hours of age, the infant had seizure activity that included rhythmic movement of both upper extremities, hiccupping, and repetitive chewing movements. An electroencephalogram was grossly abnormal, showing paroxysmal bursts of activity (seizures) and periods of suppression. Phenobarbital was given to alleviate the seizure activity. 

It is not surprising that infant L. suffered diffuse encephalopathy (brain disorder), a cerebral infarction, and seizures during the neonatal period (Yager, 2002). Both asphyxia and hypoglycemia are injurious to the brain. The treatment for seizures consists of providing normal metabolic substrates (e.g., glucose) and appropriate anticonvulsant therapy (phenobarbital), as was done in the present case. The long-term treatment for the child s developmental disabilities is complex and involves the skills of many members of the health care team. 

The major route of elimination is hepatic metabolism. The variability in the metabolism and pharmacokinetics in neonates, infants and children necessitates monitoring of drug concentrations in the plasma, particularly when it is co-administered with phenytoin, phenobarbital or rifampin. 

Antiepilepsy. General note of caution observe the infant for sedation and poor suckling. Primidone, ethosuximide and phenobarbital are present in milk in high amounts phenytoin and sodium valproate less so. 

Elixirs are sweetened hydroalcoholic oral solutions that are specially formulated for oral use in infants and children. Digoxin, a non-ionizable cardiotonic glycoside, is practically insoluble in water and is solubilized in propylene glycol, 10% ethanol, flavor, sweetener, preservative, and buffers to 50pg/ml in Lanoxin Elixir Pediatric from which the oral bioavailability of digoxin is 70-85%. Phenobarbital, an anticonvulsant and sedative with an intrinsic water solubility of 1 mg/ml, is solubilized in water, 23% ethanol, glucose, sodium saccharin, and flavors to 3.5 mg/ml in Donnatal Elixir. 

Drug ahsorption from an intramuscular site also may he altered in premature infants. Differences in relative muscle mass, poor perfusion to various muscles, peripheral vasomotor instability, and insufficient muscular contractions in premature infants compared with older children and adults can influence drug absorption from the intramuscular site. The net effect of these factors on drug absorption is impossible to predict phenobarbital has been reported to be absorbed rapidly, whereas diazepam absorption may be delayed." Thus intramuscular dosing is used rarely in neonates except in emergencies or when an intravenous site is inaccessible. 

Metabolism of drugs such as theophyUine, phenobarbital, and phenytoin by oxidation is also impaired in newborn infants. The rate of metabolism, however, is more rapid with phenobarbital and phenytoin than with theophylline, perhaps owing to the involvement of different cytochrome P450 isozymes. Total clearance of phenytoin by CYP2C9 and to a lesser extent by C YP2C19 surpasses adult values by 2 weeks... 

Except for the less lipid-soluble aprobarbital and phenobarbital, nearly complete metabolism and/or conjugation of barbiturates in the liver precedes their renal excretion. The metabolic elimination of barbiturates is more rapid in young people than in the elderly and infants, and half-lives are increased during pregnancy partly because of the expanded volume of distribution. Chronic liver disease, especially cirrhosis, often increases the tj of the biotransformable barbiturates. Repeated administration, especially of phenobarbital, shortens the tj of barbiturates that are metabolized as a result of the induction of microsomal enzymes (see above). 

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