At a Glance
Why Get Tested?
To monitor the phenobarbital level in the blood to ensure a therapeutic level while avoiding toxic side effects
When to Get Tested?
A blood sample drawn from a vein in your arm
Test Preparation Needed?
The Test Sample
What is being tested?
This test measures the level of phenobarbital in the blood. Phenobarbital is a barbiturate, an antiepileptic drug (AED) and sedating drug that depresses the nervous system. Doctors usually prescribe it to prevent seizures or to relieve anxiety. It is often prescribed to treat epilepsy and other seizure disorders because the drug stabilizes electrical activity in the brain.
It is important to maintain a stable level of phenobarbital in the blood within the therapeutic range. If the level is too low, the person who is being treated may experience seizures or anxiety. If the level is too high, the individual could experience side effects or even toxicity.
Maintaining a constant, therapeutic level of phenobarbital in the blood can be difficult. The difference between the level at which the drug is therapeutic and the level at which toxic side effects can occur is very small. This is called a narrow therapeutic index and is a primary reason the drug requires close monitoring.
Futhermore, phenobarbital is metabolized by liver enzymes and eliminated in the urine at different rates, depending on a person's 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 metabolize phenobarbital, 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.
A doctor will monitor an individual's response to phenobarbital to make sure that the desired level of the drug is maintained in the blood and to determine the dose that works best for the person treated. The doctor might order a phenobarbital level at the start of treatment and any time while the person is on the medication to determine if the dose is right. The doctor might also decide to order a test if a person begins taking another medication because several common drugs can affect how the body responds to phenobarbital. Drugs that can have effects with phenobarbital include warfarin, antidepressants, sedatives, hypnotics, tranquilizers, antihistamines, alcohol, oral contraceptives, corticosteroids like prednisone, and other antiepileptic medications such as phenytoin.
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.
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Sources Used in Current Review
(September 27 2012) National Institutes of Health's Medline Plus. Phenobarbital. Available online at http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682007.html. Accessed October 2012.
(September 25, 2012) Ochoa J. Antiepileptic Drugs. Medscape Reference. Available online at http://emedicine.medscape.com/article/1187334-overview through http://emedicine.medscape.com. Accessed October 2012.
(December 2, 2011) Cavasos J. Epilepsy and Seizures. Medscape Reference. Available online at http://emedicine.medscape.com/article/1184846-overview through http://emedicine.medscape.com. Accessed October 2012.
(April 28, 2011) Mayo Clinic. Epilepsy Treatment and Drugs. Available online at http://www.mayoclinic.com/health/epilepsy/DS00342/DSECTION=treatments-and-drugs through http://www.mayoclinic.com. Accessed October 2012.
Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Burtis CA, Ashwood ER, Bruns DE, eds. 4th edition, St. Louis: Elsevier Saunders; 2006, Pp 1252-1253.
Sources Used in Previous Reviews
National Institutes of Health's MedlinePlus. Phenobarbital. Available online at http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682007.html. Reviewed October 1, 2007. Accessed October 3, 2008.
NetdoctorUK.com. Phenobarbital. Available online at http://www.netdoctor.co.uk/medicines/10002060.html through http://www.netdoctor.co.uk. Reviewed August 1, 2007. Accessed October 3, 2008.
Warner, A. et al. Standards of laboratory practice: Antiepileptic Drug Monitoring. Clinical Chemistry 1998; 44:1085–1095. Available online at http://www.clinchem.org/cgi/reprint/44/5/1085 through http://www.clinchem.org. Accessed October 4, 2008.
Kwan, P. and Brodie, M. Phenobarbital for the Treatment of Epilepsy in the 21st Century: A Critical Review. Epilepsia 2004; 9: 1141-1149. Available online at https://www3.interscience.wiley.com/cgi-bin/fulltext/118751051/HTMLSTART?CRETRY=1&SRETRY=0 through https://www3.interscience.wiley.com. Accessed October 4, 2008.
American Society of Health System Pharmacists. Phenobarbital (Systemic). Available online at http://www.ashp.org/mngrphs/essentials/a382855e.htm through http://www.ashp.org. Revised August 2007. Accessed October 5, 2008.
San Diego Reference Laboratory. Phenobarbital. Available online at http://www.sdrl.com/druglist/phenobarbital.html through http://www.sdrl.com. Accessed October 7, 2008.
Burgess, C. ed. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 4th Edition, 2006. P. 2312.
Epilepsy Therapy Development Project. Children and Phenobarbital. Available online at http://professionals.epilepsy.com/medications/p_phenobarbital_children.html through http://professionals.epilepsy.com. Accessed October 5, 2008.
Emory School of Medicine, Department of Human Genetics. Seizures and Pregnancy. PDF available for download at http://www.genetics.emory.edu/pdf/Emory_Human_Genetics_Seizures_Pregnancy.PDF through http://www.genetics.emory.edu. Issued 2004. Accessed October 7, 2008.
UC San Diego Medical Center. Safety of Commonly Used Drugs in Nursing Mothers. Available online at http://health.ucsd.edu/specialties/pharmacy/resources/breastfeeding.asp through http://health.ucsd.edu. Reviewed April 2005. Accessed October 8, 2008.
Spencer, Jeanne P. et al. American Family Physician. Medications in the Breast Feeding Mother. Published July 1, 2001. Available online at http://www.aafp.org/afp/20010701/119.html through http://www.aafp.org. Accessed October 8, 2008.
Food and Drug Administration. Information for Healthcare Professionals: Suicidality and Antiepileptic Drugs. Available online at http://www.fda.gov/cder/drug/InfoSheets/HCP/antiepilepticsHCP.htm through http://www.fda.gov. Issued January 31, 2008. Accessed October 4, 2008.
Reinberg, Steve. FDA Advisers Don't Back 'Black Box' Warning for Epilepsy Drugs. The Washington Post. Available online at http://www.washingtonpost.com/wp-dyn/content/article/2008/07/10/AR2008071002527.html through http://www.washingtonpost.com. Published July 10, 2008. Accessed October 7, 2008.