Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include cold, clammy skin; change in size of pupil; deep sleep; loss of consciousness; slowed or fast breathing.
Proper storage of Phenobarbital tablets:
Store Phenobarbital tablets at room temperature (59 to 86 degrees F; 15 to 30 degrees C) in a tightly closed container. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Phenobarbital tablets out of the reach of children and away from pets.
Overdose of Phenobarbital in details
When a dose is taken in higher dose than the recommended doses, it is called Overdose. Overdose always needs a clinical supervision. Any medicine or drug when consumed in Overdose produces untoward side effects on one or various organs in the body. A medicine is excreted in the kidney or metabolized in the liver most of the times. This process goes without any hurdles when taken in normal dose, but when taken in an overdose, the body is not able to metabolize it or send it out properly which causes the effects of anoverdose.
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Signs and Symptoms
The onset of symptoms following a toxic oral exposure to Phenobarbital may not occur until several hours following ingestion. The toxic dose of barbiturates varies considerably. In general, an oral dose of 1 g of most barbiturates produces serious poisoning in an adult. Death commonly occurs after 2 to 10 g of ingested barbiturate. The sedated, therapeutic blood levels of Phenobarbital range between 5 to 40 mcg/mL; the usual lethal blood level ranges from 100 to 200 mcg mL. Barbiturate intoxication may be confused with alcoholism, bromide intoxication, and various neurologic disorders. Potential tolerance must be considered when evaluating significance of dose and plasma concentration.
The manifestations of a long-acting barbiturate in overdose include nystagmus, ataxia, CNS depression, respiratory depression, hypothermia, and hypotension. Other findings may include absent or depressed reflexes and erythematous or hemorrhagic blisters (primarily at pressure points). Following massive exposure to Phenobarbital, pulmonary edema, circulatory collapse with loss of peripheral vascular tone, cardiac arrest, and death may occur.
In extreme overdose, all electrical activity in the brain may cease, in which case a "flat"EEG normally equated with clinical death should not be accepted. This effect is fully reversible unless hypoxic damage occurs.
Consideration should be given to the possibility of barbiturate intoxication even in situations that appear to involve trauma.
Complications such as pneumonia, pulmonary edema, cardiac arrhythmias, congestive heart failure, and renal failure may occur. Uremia may increase CNS sensitivity to barbiturates if renal function is impaired. Differential diagnosis should include hypoglycemia, head trauma, cerebrovascular accidents, convulsive states and diabetic coma.
Treatment
To obtain up-to-date information about the treatment of overdose, a good resource is your certified Regional Poison Control Center. Telephone numbers of certified poison control centers are listed in the Physicians' Desk Reference (PDR). In managing overdosage, consider the possibility of multiple drug overdoses, interaction among drugs, and unusual drug kinetics in your patient.
Protect the patient's airway and support ventilation and perfusion. Meticulously monitor and maintain, within acceptable limits, the patients vital signs, blood gases, serum electrolytes, etc. Absorption of drugs from the gastrointestinal tract may be decreased by giving activated charcoal, which, in many cases, is more effective then emesis or lavage; consider charcoal instead of or in addition to gastric emptying. Repeated doses of charcoal over time may hasten elimination of some drugs that have been absorbed. Safeguard the patient's airway when employing gastric emptying or charcoal.
Alkalinization of urine hastens Phenobarbital excretion, but dialysis and hemoperfusion are more effective and cause less troublesome alteration in electrolyte equilibrium. If the patient has chronically abused sedatives, withdrawal reactions may be manifest following acute overdose.
What should I avoid while taking Phenobarbital?
This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.
Drinking alcohol can increase some of the side effects of Phenobarbital.
Phenobarbital warnings
Warnings are a mix of Precautions. Contraindications and interactions and serious harmful effects associated with the medicine intake. A diabetic or Hypertensive patient need to be warned about few drug interactions. A known hypersensitivity patient needs to be careful about the reactions or anaphylactic shock. A pregnant woman or a breastfeeding woman should be warned of certain medications. A Hepatitis [liver disease] patient or a cardiac patient should avoid few drugs.
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1. Habit forming: Phenobarbital may be habit forming. Tolerance, psychological and physical dependence may occur with continued use.. To minimize the possibility of overdosage or the development of dependence, the prescribing and dispensing of sedative-hypnotic barbiturates should be limited to the amount required for the interval until the next appointment. Abrupt cessation after prolonged use in the dependent person may result in withdrawal symptoms, including delirium, convulsions, and possibly death. Phenobarbital should be withdrawn gradually.
2. Acute or chronic pain: Caution should be exercised when Phenobarbital is administered to patients with acute or chronic pain, because paradoxical excitement could be induced or important symptoms could be masked. However, the use of Phenobarbital as a sedative in the postoperative surgical period and as an adjunct to cancer chemotherapy is well established.
3. Use in pregnancy: Phenobarbital can cause fetal damage when administered to a pregnant woman. Retrospective case-controlled studies have suggested a connection between the maternal consumption of Phenobarbital and higher than expected incidence of fetal abnormalities. Following oral administration, Phenobarbital readily crosses the placental barrier and is distributed throughout fetal tissues with highest concentrations found in the placenta, fetal liver, and brain.
Withdrawal symptoms occur in infants born to mothers who receive Phenobarbital throughout the last trimester of pregnancy. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus.
4. Synergistic effects: The concomitant use of alcohol or other CNS depressants may produce additive CNS depressant effects.
What should I discuss with my healthcare provider before taking Phenobarbital?
Some medical conditions may interact with Phenobarbital elixir. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:
if you are pregnant, planning to become pregnant, or are breast-feeding
if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
if you have allergies to medicines, foods, or other substances
if you have depression, pain, breathing problems, suicidal tendencies, or are in shock
if you have a history of substance abuse or dependence
Some MEDICINES MAY INTERACT with Phenobarbital elixir. Tell your health care provider if you are taking any other medicines, especially any of the following:
Ethanol, MAO inhibitors (eg, phenelzine), quinine, sodium oxybate (GHB), stiripentol, or valproic acid because side effects such as increased sedation and difficulty breathing may occur
Ethanol, methoxyflurane, orsodium oxybate because the risk of their side effects may be increased by Phenobarbital elixir
Anticoagulants (eg, warfarin), beta-blockers (eg, propranolol), clozapine, corticosteroids (eg, hydrocortisone), cyclosporine, doxorubicin, doxycycline, estrogens (eg, estradiol), imatinib, metronidazole, steroidal contraceptives (eg, birth control pills), theophylline, or voriconazolebecause their effectiveness may be decreased by Phenobarbital elixir
This may not be a complete list of all interactions that may occur. Ask your health care provider if Phenobarbital elixir may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.
Phenobarbital precautions
Certain people who are very sick or very old or who are sensitive show an exacerbation of side effect of the drug which can turn dangerous at times. So, it is very important to remember the precautions while taking the medicine. Pregnancy and Breastfeeding are also special categories wherein extra care or precaution is needed when taking a drug. Few patients may have a hypersensitivity reaction to few medications, and that can be life-threatening rarely. Penicillin hypersensitivity is one example. Diarrhea, rashes are few other symptoms which need a watch. A patient with other co-existing diseases like liver disease, heart disease, kidney disease should take special precautions.
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General
Phenobarbital may be habit forming. Tolerance and psychological and physical dependence may occur with continuing use. Phenobarbital should be administered with caution, if at all, to patients who are mentally depressed, have suicidal tendencies, or a history of drug abuse. Elderly or debilitated patients may react to Phenobarbital with marked excitement, depression, and confusion. In some persons, Phenobarbital repeatedly produces excitement rather than depression.
In patients with hepatic damage, Phenobarbital should be administered with caution and initially reduced doses. Phenobarbital should not be administered to patients showing the premonitory signs of hepatic coma.
Laboratory Tests
Prolonged therapy with Phenobarbital should be accompanied by periodic laboratory evaluation of organ systems, including hematopoietic, renal, and hepatic systems
Carcinogenesis
Human-data: A retrospective study of 84 children with brain tumors matched to 73 normal controls and 78 cancer controls (malignant disease other than brain tumors) suggested an association between exposure to barbiturates prenatally and an increased incidence of brain tumors.
Pregnancy
Teratogenic effects: Pregnancy Category D.
Nonteratogenic effects: Reports of infants suffering from long- term Phenobarbital exposure in utero included the acute withdrawal syndrome of seizures and hyperirritability from birth to a delayed onset of up to 14 days.
Labor and Delivery
Hypnotic doses of Phenobarbital do not appear to significantly impair uterine activity during labor. Full anesthetic doses of Phenobarbital decrease the force and frequency of uterine contractions. Administration of sedative-hypnotic Phenobarbital to the mother during labor may result in respiratory depression in the newborn. Premature infants are particularly susceptible to the depressant effects of Phenobarbital. If Phenobarbital is used during labor and delivery, resuscitation equipment should be available.
Data are currently not available to evaluate the effect of Phenobarbital on the later growth, development, and functional maturation of the child.
Nursing Mothers
Caution should be exercised when Phenobarbital is administered to a nursing woman since small amounts of Phenobarbital are excreted in the milk.
What happens if I miss a dose of Phenobarbital?
When you miss a dose, you should take it as soon as you remember, but you should take care that it should be well spaced from the next dose. You should not take an extra dose at the time of the second dose as it will become a double dose. The double dose can give unwanted side effects, so be careful. In chronic conditions or when you have a serious health issue, if you miss a dose, you should inform your health care provider and ask his suggestion.
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
NITE-CMC. "5-Ethyl-5-phenyl-2,4,6(1H,3H,5H)-pyrimidinetrione; Phenobarbital: The chemical classification in this section was conducted by the Chemical Management Center (CMC) of Japan National Institute of Technology and Evaluation (NITE) in accordance with GHS Classification Guidance for the Japanese Government, and is intended to provide a reference for preparing GHS labelling and SDS for users.". http://www.safe.nite.go.jp/english/g... (accessed September 17, 2018).
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