Phenobarbital

• euphoric feelings,
• reduced inhibition,
• feelings of calm/relaxation,
• increased ability to sleep ².

• oral – 15 – 60 minutes ³, 15 – 45 minutes ⁴.
• intravenous – 1 – 5 minutes ⁴.

• oral – 4 – 6 hours ³.

• oral – 5 – 8 hours ⁴.
• intravenous – 4 – 6 hours ⁴.

• oral – 1 – 48 hours ³, 1 – 24 hours ⁴.
• intravenous – 1 – 24 hours ⁴.

Phenobarbital, the longest-acting barbiturate, is used for its anticonvulsant and sedative-hypnotic properties in the management of all seizure disorders except absence (petit mal) ¹.

Absorbed in varying degrees following oral, rectal or parenteral administration. The salts are more rapidly absorbed than are the acids. The rate of absorption is increased if the sodium salt is ingested as a dilute solution or taken on an empty stomach ¹.

70% – 90% ⁵.

Hepatic (mostly via CYP2C19) ¹.

53 to 118 hours (mean 79 hours) ¹.

Excretion – urine (major) ⁵.

LD50the amount of a material, given all at once, which causes the death of 50% (one half) of a group of test animals. The LD50 is one way to measure the short-term poisoning potential (acute toxicity) of a material 3.1244 mol/kg in rats ¹.

Tolerancethis is the process by which the receptors in your brain become habituated to the action of a drug. When tolerance is reached, more of the drug is required to achieve the same effect. With benzodiazepines, and probably with many other classes of drugs as well, tolerance is virtually always associated with some degree of physical dependence. If you find that you are experiencing tolerance, this is a clear warning sign that you may have formed a dependence. More will develop to the sedative-hypnotic effects of phenobarbital after prolonged use. It is unknown exactly how long it takes for tolerancethis is the process by which the receptors in your brain become habituated to the action of a drug. When tolerance is reached, more of the drug is required to achieve the same effect. With benzodiazepines, and probably with many other classes of drugs as well, tolerance is virtually always associated with some degree of physical dependence. If you find that you are experiencing tolerance, this is a clear warning sign that you may have formed a dependence. More to reach baseline. Phenobarbital presents cross-tolerance with all barbiturates, meaning that after its consumption all barbiturates will have a reduced effect ³.

Phenobarbital acts on GABAA receptorsnerve endings that sense changes in the body More, increasing synaptic inhibition. This has the effect of elevating seizure threshold and reducing the spread of seizure activity from a seizure focus. Phenobarbital may also inhibit calcium channels, resulting in a decrease in excitatory transmitter release. The sedative-hypnotic effects of phenobarbital are likely the result of its effect on the polysynaptic midbrain reticular formation, which controls CNSthe Central Nervous System, upon which certain drugs act arousal ¹.

Barbiturate overdose may occur when a barbiturate is taken in extremely heavy quantities or concurrently with other depressants. This is particularly dangerous with other GABAergic depressants such as benzodiazepines and alcohol since they work in a similar fashion, but bind to distinct allosteric sites on the GABAA receptor, thus their effects potentiate one another. Benzodiazepines increase the frequency in which the chlorine ion pore opens on the GABAA receptor while barbiturates increase the duration in which they are open, meaning when both are consumed, the ion pore will open more frequently and stay open longer ⁶. Barbiturate overdose is a medical emergency that may lead to a coma, permanent brain injury or death if not treated promptly and properly. Barbiturate overdose has an increased frequency of serious adverse effects when compared to other depressants ³.

• drowsiness,
• fatiguea feeling of weariness, tiredness, or lack of energy. More,
• nausea,
• vomiting,
• slowed heart rate,
• respiratory depressionslowing the drive and effectiveness of breathing More,
• uncoordinated muscle movements,
• nystagmusrapid involuntary rhythmic movement of the eyes More,
• dizziness,
• impaired thinking processes,
• paradoxical neural excitation,
• coma,
• overdose ⁹.

• difficulty maintaining alertness,
• poor functioning at home, work, or school,
• mood disturbances,
• irritability,
• depression,
• suicidality,
• cognitive decline,
• problems with memory consolidation and recall ⁹.

• muscle relaxation,
• physical euphoriaan intense feeling of pleasure and well-being More,
• motor control loss,
• respiratory depressionslowing the drive and effectiveness of breathing More,
• sedationthe state of being relaxed or sleepy because of a drug More,
• seizure suppression,
• decreased blood pressure,
• dizziness ³.

• cognitive euphoriastate of intense well-being, happiness, and excitement More,
• compulsive redosing,
• delusions,
• amnesiainability to remember,
• analysis suppression,
• anxiety suppression,
• decreased libido,
• disinhibition,
• emotion suppression,
• information processing suppressioncan be described as a partial to complete suppression of a person's ability to process information and logically analyse a situation in an understandable and linear fashion. This is something which can result in states of stupor, indecisiveness, confusion and even irrational behaviour or delirium. More,
• language suppression,
• thought deceleration ³.

• acuity suppression ³.

• ataxialoss of motor coordination More,
• dizziness,
• drowsiness,
• dysarthriaa condition in which the muscles you use for speech are weak or you have difficulty controlling them. Dysarthria often is characterised by slurred or slow speech that can be difficult to understand. More,
• fatiguea feeling of weariness, tiredness, or lack of energy. More,
• headache,
• irritability,
• nystagmusrapid involuntary rhythmic movement of the eyes More,
• paresthesia restlessness,
• vertigoa medical condition where a person feels as if they or the objects around them are moving when they are not. Often it feels like a spinning or swaying movement More ⁵.

• mental dullness,
• constipationmeans that you're not passing stools regularly or you're unable to completely empty your bowels. More,
• diarrhoeaWhere you frequently pass watery or loose faeces,
• nausea,
• vomiting,
• megaloblastic (folate-deficiency) anaemialow red blood cell count ⁵.

• rash,
• hypocalcaemialow calcium levels in the blood. More,
• hepatotoxicitychemical-driven liver damage. More ⁵.

• Stevens-Johnson syndrome,
• rickets,
• osteomalaciaa weakening of the bones that can lead to serious health complications. More ⁵.

• blisters and lesions on the skin,
• dilated pupils,
• double vision,
• ataxialoss of motor coordination More,
• loss of muscular coordination,
• altered consciousness and behaviour,
• slurred speech,
• liver damage ¹⁰.

• nystagmusrapid involuntary rhythmic movement of the eyes More,
• loss of coordination,
• drowsiness,
• slowed breathing,
• drop in body temperature,
• blisters ¹¹,
• confusiontrouble focusing, slow or disorganised thinking, poor short-term memory, unsure of time or place, or having difficulty following a conversation,
• delirium,
• deep sleep,
• coma,
• low blood pressure,
• slurred speech,
• unsteady gait,
• weak pulse,
• excitement,
• headaches ¹².

Detoxification is the first step in phenobarbital addiction treatment. A person cannot obtain sobriety without going through this critical process. Drug residue in the body can spark cravings for the drug, which can lead to drug-seeking behaviors and relapse. To avoid this, it is important to complete the detoxification process even though it may be uncomfortable.

During phenobarbital detox, the body divests itself of all traces of the drug. The process can take a few days to a few weeks depending on the length of time and the dosage amount of phenobarbital the person consumed. Once detoxification has completed, the person usually will not experience physical cravings for the drugs any longer.

Many treatment centres, and especially luxury facilities, prescribe additional therapies that complement the detoxification process. Nutritional therapy is a popular one prescribed to patients. People who abuse drugs often suffer from nutritional deficiencies that can make it harder for the body to heal itself. A person is usually put on a special diet that alleviates this problem and provides the body with the vitamins and minerals it needs to become healthier.

Other popular therapies include the use of herbal remedies, acupuncture, and cognitive-behavioural techniques. It is important to communicate with the person who is helping you through detoxification to make sure your phenobarbital addiction treatment addresses your specific needs ⁷.

After phenobarbital detox is over, the person continues to the next phase of his or her phenobarbital addiction treatment. Typically, this is the phase where the person’s psychological addiction to the drug is addressed. Although a person may no longer have physical cravings for the drug, unaddressed mental and emotional cravings can lead to a relapse into the addiction.

Psychological cravings for a drug can sometimes be stronger than physical cravings. A person is typically prescribed counselling or psychotherapy to tackle the underlying reasons for his or her addiction. Additionally, the person is provided with the skills he or she needs for successful reintegration into society and to handle challenges of living a drug-free life ⁷.

Some of the skills a person may be taught include –

• recognising situations that may trigger drug cravings or a relapse,
• learning to handle pressure from peers to take drugs,
• asking for help when the temptation to take drugs arises,
• coping skills for handling the stresses of daily life,
• maintaining mental and physical health ⁷.

Phenobarbital addiction treatment may include the development of an aftercare plan. Part of this aftercare plan may be to create a support network that will help you maintain your sobriety. You may be encouraged to join a 12-step program that can provide continuing education and socialisation opportunities.

After going through the process of overcoming a phenobarbital addiction, no one wants to relapse into the addiction. However, it is important to be realistic about the possibility of a relapse occurring. It is better to have a plan and never need it than to not have a plan and not know what to do if you relapse. Before leaving the phenobarbital addiction treatment centre, work closely with the addiction specialist on a relapse strategy that will quickly get you back on track if one occurs ⁷.