Which medications in the drug class Anticonvulsants, Barbiturates are used in the treatment of Epilepsy and Seizures?

Updated: May 30, 2019
  • Author: David Y Ko, MD; Chief Editor: Selim R Benbadis, MD  more...
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Answer

Anticonvulsants, Barbiturates

Like benzodiazepines, barbiturates bind to the gamma-aminobutyric acid (GABA) receptor, enhancing the actions of GABA by extending GABA-mediated chloride channel openings and allowing neuronal hyperpolarization. The principal barbiturate used for status epilepticus is phenobarbital; for refractory cases, pentobarbital is used.

Phenobarbital (Luminal)

Phenobarbital works at GABA receptors in the central nervous system (CNS) to potentiate CNS inhibition. This agent is the best-studied barbiturate for the treatment of status epilepticus.

In status epilepticus, achieving therapeutic levels as quickly as possible is important. Intravenous dosing may require approximately 15 minutes to attain peak levels in the brain. To terminate generalized convulsive status epilepticus, administer up to 15-20 mg/kg. If the patient has received a benzodiazepine, the potential for respiratory suppression significantly increases. Ventilation and intubation may be necessary. Hypotension may require treatment.

In status epilepticus, phenobarbital is generally used after phenytoin or fosphenytoin fails. However, it can be used in lieu of phenytoin in certain circumstances. A trend is to recommend agents other than phenobarbital (propofol, midazolam, other barbiturates) for refractory status epilepticus; however, for super-refractory status epilepticus, phenobarbital should be used.

Primidone (Mysoline)

Primidone is indicated for the management of grand mal, psychomotor, and focal seizures. In addition, it is commonly used for benign familial tremors. When metabolized, primidone breaks down to phenobarbital, another active antiepileptic drug. Primidone decreases neuron excitability and increases the seizure threshold. Common side effects of this drug include sedation, drowsiness, fatigue, and depression.


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