Talk:Phenobarbital

message: I work as a volunteer in a local excellent hospital Seattle Childrens Hospital. I can assure you that phenobarbital has been used for every patient with seizures that I've visited in the last month. This is in an affluent country in a very good hospital. Where is the claim that it is not used in affluent countries from? Perhaps not in the UK, I understand that, but the generalization doesn't hold. laddiebuck 01:51, 7 September 2006 (UTC)
replies: text: Thanks for your meticulous research. I will try to find information for you. The behavioral side-effects of phenobarbital are known, I've heard them being discussed in the care conferences for patients. Here is some info:
* The three main drugs prescribed are phenobarbital, dilantin, and keppra (I realize I'm mixing trade names and chemical names, but I am just repeating usage). The ketogenic diet, which Wikipedia describes as not mainstream, is also used.
* I see mainly young patients, between the ages of 0-9. I sometimes see patients above that age, but not enough to be statistically significant.
I will ask the next chance I have for some more concrete documentation on the consensus on using these drugs in the US, or at least this hospital's policy on them. I'll post that to the talk page. 
laddiebuck 23:49, 7 September 2006 (UTC)

text: BTW the Wikipedia ketogenic diet article could do with some work. If by "not mainstream" you mean "alternative therapy" then the article is certainly giving the wrong impression. Although not a first-line choice, the diet is certainly an accepted option for refractory epilepsy in children. For example, NICE guidelines recommend "The ketogenic diet should not be recommended  for adults with epilepsy" but "The ketogenic diet may be considered as an adjunctive treatment in children with drug-resistant epilepsy." The SIGN guidelines say "The ketogenic diet has a role to play in the management of intractable epilepsy and significant proportions of children will experience clinically significant seizure reduction. This technique should be supervised in a unit where expertise in the diet exists." In other words, it requires referral to a tertiary hospital or clinic in order to get access to the experts. Typically this means a neurologist and dietician with experience – which is probably the biggest problem. Colin°Talk 10:18, 8 September 2006 (UTC)
replies: text: In Germany, 1st line are clearly valproate, carbamazepine/oxcarbazepine, lamotrigine, 2nd line are phenytoin, topiramate and the "add-ons", like levetiracetam, clonazepam, clobazam, tiagabine, vigabatrine, felbamate, gabapentin etc.; Phenobarbital (and also Phenytoin) are used as 2nd line in i.v.-therapy of a status epi and Phenobarbital/Primidone as a rather "end-line" option for long-term treatment in all ages, save for the patients, taking it as p.o. maintenance for years and in particular refractory cases, where multiple newer AEDs aren't well tolerated or effective.--84.163.86.78 (talk) 01:30, 5 February 2008 (UTC)
replies: text: Ow I forgot the succinimides, they are somewhere between 2nd and 3rd line for p.o. maintenance, largerly replaced by the newer AEDs.--84.163.124.150 (talk) 01:32, 5 February 2008 (UTC)
thread_title: Volunteer comment

message: I changed the indication from "the drug of choice in dogs" to "one of the initial drugs" because both phenobarbital and bromide are currently considered the two first-line drugs for dogs with epilepsy.
I added that phenobarbital is the initial drug of choice for cats.
I removed the mention of phenobarbital in the treatment of status because although it is a good drug to prevent further seizures, it's relatively low lipid solubility means it does not enter the brain quickly, even with intravenous administration, so it's not as useful in the emergency treatment of status. In dogs and cats with status refractory to diazepam, pentobarbital or propofol are usually preferred because of their more rapid onset of anti-seizure activity.
Merck may not be the best reference for my changes. Better might be:
Thomas WB. Seizures and narcolepsy. In: Dewey CW (ed). A Practical Guide to Canine and Feline Neurology. Iowa State Press. 2003.
But I was not sure exactly if it's better to add a reference or change a reference. Please feel free to add this reference or not.
Thanks
Loupe 21:25, 11 October 2006 (UTC)
replies: text: Thanks for your edit – I am not a veterinarian, and added information from the Merck Manual simply because it was easily available to me and I am familiar with it, not because it was the best source. I will add the reference you provided; if you'd like to expand this section, feel free to. The phenobarbital article has been sort of an unofficial collaborative project on WP:DRUGS, and I'm sure any further reliable information you could add would be much appreciated. Thanks again, Fvasconcellos 21:45, 11 October 2006 (UTC)
thread_title:  Veterinary uses 

message: In the section "Indications", there is a cited quote, that
Concerns that neonatal seizures in themselves could be harmful make most physicians treat them aggressively. There is, however, no reliable evidence to support this approach.[18]
while this is provided by a link to source, it is disputable in my opinion. Every seizure is considered a medical emergency per se. Even more so to be concerned in little children, since their skeletons are not fully developped and the central nervous system can take bad damages due to the seizure itself, or due to hypoxia caused by respiration problems during seizure. Thus, the "aggressive therapy" is important, in my opinion.--Spiperon 00:06, 22 October 2006 (UTC)
thread_title:  Concerns about febrile seizures in children 

message: Phenobarbital confers its diverse effects by activating the orphan nuclear receptor car.
Ion channels and epilepsy.  
"enhancement of GABA(A) inhibitory transmission is the primary mechanism of benzodiazepines and phenobarbital" 
 GABA(A) is a class of receptors to GABA.  GABA is the most widespread inhibitory neurotransmitter in the brain, but I would want to check more than I have time for now before I would write the section of the article.
The first link seems to be about effects unrelated to its anticonvulsant action.
--dsws (talk) 05:59, 25 February 2008 (UTC)
thread_title:  More links for mechanism of action 

message: I have reinserted the section describing the use by Nazi doctors during WWII of Phenobarbitol to kill deformed children. It was removed in this edit by an anonymous user claiming that it was irrelevant however this is a significant part of the history of the drug and so I assert that it belongs in the history section of this article. Kingbenny (talk) 09:47, 5 June 2008 (UTC)
replies: text: It is not censorship. Such information belongs in articles on Nazi atrocities and eugenics. From the aspect of phenobarbital it is not important. Colin°Talk 10:03, 6 November 2010 (UTC)
thread_title:  Possible historical cleansing? 

message: Which is a copy of which? The Wiki entry, or this page I found on the same search.
http://www.absoluteastronomy.com/topics/Phenobarbital
--71.8.66.22 (talk) 03:13, 13 February 2009 (UTC)
thread_title:  Article itself 

message: In response to the request for citation in this section, the use of phenobarbital for patients in benzodiazepine withdrawal appears to be documented. The following journal article may be of service, but I do not have the necessary editing ability to add the citation in a neat and cohesive manner myself. http://www.aafp.org/afp/980700ap/miller.html
Malusmoriendumest (talk) 15:24, 10 September 2010 (UTC)
thread_title:  Side Effects 

message: As an Accute-Victim of Hypoglycaemic-Seizures, I--Michael A. Rorer, now-residing in Portsmouth, VA.--would like to Commend Phenobarbital's Unique-Abilities to FULLY-CONTROL My-Own Hypoglycaemic-Seizures! -- I,
personally, have been a "Phenobarbital-Patient"--since 1946, when it was
"Relatively-New"! And--on EVERY-OCCASION, folks--when "a "Newer-Breed of Physicians," has decided that I "No-Longer-NEEDED Phenobarb," which, many of them, described as: "A Model-T-Drug, which has--Long-Ago--Out-
lived its Usefulness"--Taking-ME-OFF Phenobarbital!--we've ALL had DIS-
ASTEROUS-Results!!! My Hypoglycaemic-Seizures--with SEVERE, One-Sided-Headaches, and TOTAL-LOSS of Recent-Memory!--ALWAYS-Returning! -- I, for One, Wholeheartedly-SUPPORT Phenobarbital--So Long as Carefully-Taken, in Accordance with Strict-Medical & Pharmaceutical-Guidelines!!!  — Preceding unsigned comment added by 70.160.13.202 (talk) 01:57, 17 February 2013 (UTC)
thread_title:  Hypoglycaemia & Phenobarbital 

message: Why does Helional redirect to Phenobarbital?  They are completely different compounds.  — Preceding unsigned comment added by 58.165.187.164 (talk) 12:14, 5 September 2013 (UTC)
thread_title:  Helional? 

message: In the Other Uses section, the following notation appears:
Phenobarbital is a commonly used agent in high purity and dosage for lethal injection of "death row" criminals.
Aside from the poor wording, there is no source for this statement.
Citing the Death Penalty Information Center, they note only Arkansas has used phenobarbital as a death penalty drug.
On that page about Arkansas, the DPIC notes:
Announced plans to use phenobarbital in executions. No other state considered using or planned to use the drug in executions. (AP, 4/16/13) State has now abandoned plans to use phenobarbital. (Arkansas News Bureau, 6/17/13)
184.6.71.139 (talk) 05:43, 31 August 2016 (UTC)
thread_title:  Other Uses Item Unsourced 

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thread_title:  External links modified 

message: The very article says phennies are a low-risk stuff, so I don't think we need to moralize the reader about its supposed risk of addiction and side-effects (which med doesn't have them?) in case of insomnia treatment based on just one random Google Book. According to this logic nothing whatsoever could be done to treat insomnia...Miacek  (talk) 08:35, 16 May 2018 (UTC)
thread_title:  Moralization 

message: Not sure why the change from 1 to 2? Doc James (talk · contribs · email) 21:12, 3 October 2018 (UTC)
thread_title: Image