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Revision as of 12:06, 5 December 2011 editBeetstra (talk | contribs)Edit filter managers, Administrators172,049 edits Saving copy of the {{drugbox}} taken from revid 461217344 of page Phenobarbital for the Chem/Drugbox validation project (updated: 'DrugBank').  Latest revision as of 01:24, 12 January 2025 edit Arthurfragoso (talk | contribs)Extended confirmed users, Template editors4,591 edits dark mode fix 
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{{Short description|Medication of the barbiturate type}}
{{ambox | text = This page contains a copy of the infobox ({{tl|drugbox}}) taken from revid of page ] with values updated to verified values.}}
{{Distinguish|Pentobarbital}}
{{Drugbox
{{Distinguish|Luminol}}
| Verifiedfields = changed
{{Use dmy dates|date=August 2024}}
| verifiedrevid = 419960266
{{cs1 config|name-list-style=vanc|display-authors=6}}
| IUPAC_name = 5-ethyl-5-phenylpyrimidine-2,4,6(1''H'',3''H'',5''H'')-trione
{{Infobox drug
| image = Phenobarbital.png
| verifiedrevid = 464200457
| width = 180
| image = Phenobarbital2DACS.svg
| image2 = Phenobarbital3d_updated.png
| image_class = skin-invert-image
| width2 = 180
| width = 120
| alt = 2D chemical structure of phenobarbital
| image2 = Phenobarbital ball-and-stick.png
| image_class2 = bg-transparent
| width2 = 150
| alt2 = 3D ball-and-stick model of phenobarbital


<!--Clinical data--> <!-- Clinical data -->| pronounce =
| tradename = Luminal | tradename = Luminal, Sezaby, others
| Drugs.com = {{drugs.com|monograph|phenobarbital}} | Drugs.com = {{drugs.com|monograph|phenobarbital}}
| MedlinePlus = a682007 | MedlinePlus = a682007
| DailyMedID = Phenobarbital
| pregnancy_US = D
| pregnancy_AU = D
| pregnancy_AU_comment =
| pregnancy_category =
| dependency_liability = High<ref>{{cite book|vauthors=Bassert JM|title=McCurnin's Clinical Textbook for Veterinary Technicians - E-Book|date=2017|publisher=Elsevier Health Sciences|isbn=9780323496407|page=955|url=https://books.google.com/books?id=9ARODgAAQBAJ&pg=PA955|access-date=9 May 2020|archive-date=11 January 2023|archive-url=https://web.archive.org/web/20230111031254/https://books.google.com/books?id=9ARODgAAQBAJ&pg=PA955|url-status=live}}</ref>
| routes_of_administration = ], ], ]<ref>{{cite journal | vauthors = Hocker S, Clark S, Britton J | title = Parenteral phenobarbital in status epilepticus revisited: Mayo Clinic experience | journal = Epilepsia | volume = 59 Suppl 2 | issue = | pages = 193–197 | date = October 2018 | pmid = 30159873 | doi = 10.1111/epi.14488 }}</ref><ref>{{cite web | title=Barbiturate (Oral Route, Parenteral Route, Rectal Route) Proper Use | website=Mayo Clinic | date=7 August 2024 | url=https://www.mayoclinic.org/drugs-supplements/barbiturate-oral-route-parenteral-route-rectal-route/proper-use/drg-20069290 | access-date=15 August 2024}}</ref>
| class = ]
| ATC_prefix = N03
| ATC_suffix = AA02
| ATC_supplemental = <!-- Legal status -->
| legal_AU = S4
| legal_AU_comment =
| legal_BR = B1
| legal_BR_comment = <ref>{{Cite web |author=Anvisa |author-link=Brazilian Health Regulatory Agency |date=31 March 2023 |title=RDC Nº 784 - Listas de Substâncias Entorpecentes, Psicotrópicas, Precursoras e Outras sob Controle Especial |trans-title=Collegiate Board Resolution No. 784 - Lists of Narcotic, Psychotropic, Precursor, and Other Substances under Special Control|url=https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-784-de-31-de-marco-de-2023-474904992 |url-status=live |archive-url=https://web.archive.org/web/20230803143925/https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-784-de-31-de-marco-de-2023-474904992 |archive-date=3 August 2023 |access-date=16 August 2023 |publisher=] |language=pt-BR |publication-date=4 April 2023}}</ref>
| legal_CA = Schedule IV
| legal_CA_comment =
| legal_DE = Rx-only/Anlage III
| legal_DE_comment =
| legal_NZ = <!-- Class A, B, C -->
| legal_NZ_comment =
| legal_UK = Class B
| legal_UK_comment =
| legal_US = Schedule IV | legal_US = Schedule IV
| legal_US_comment = <ref name="Sezaby FDA label">{{cite web | title=Sezaby- phenobarbital sodium injection | website=DailyMed | date=6 January 2023 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8c7d0402-4977-4c25-bc4b-11db91339e9a | access-date=21 January 2023 | archive-date=21 January 2023 | archive-url=https://web.archive.org/web/20230121050054/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8c7d0402-4977-4c25-bc4b-11db91339e9a | url-status=live }}</ref>
| legal_status = ] (])
| legal_EU =
| routes_of_administration = Oral, rectal, parenteral (] and ])
| legal_EU_comment =
| legal_UN = <!-- N I, II, III, IV / P I, II, III, IV -->
| legal_UN_comment =
| legal_status = <!-- For countries not listed above -->


<!--Pharmacokinetic data--> <!-- Pharmacokinetic data -->| bioavailability = >95%
| bioavailability = >95%
| protein_bound = 20 to 45% | protein_bound = 20 to 45%
| metabolism = ] (mostly ]) | metabolism = ] (mostly ])
| metabolites =
| elimination_half-life = 53 to 118 hours
| onset = Within 5 min (IV); 30 min (PO)<ref name=AHFS2015 />
| excretion = ] and fecal
| elimination_half-life = 53–118 hours
| duration_of_action = 4 hours–2 days<ref name=AHFS2015 /><ref name=Marx2010 />
| excretion = ] and fecal


<!--Identifiers--> <!-- Identifiers -->| CAS_number_Ref = {{cascite|correct|??}}
| CASNo_Ref = {{cascite|correct|CAS}}
| CAS_number_Ref = {{cascite|correct|??}}
| CAS_number = 50-06-6 | CAS_number = 50-06-6
| ATC_prefix = N05
| ATC_suffix = CA24
| ATC_supplemental = {{ATC|N03|AA02}}
| PubChem = 4763 | PubChem = 4763
| IUPHAR_ligand = 2804
| DrugBank_Ref = {{drugbankcite|correct|drugbank}} | DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| DrugBank = DB01174 | DrugBank = DB01174
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| KEGG_Ref = {{keggcite|correct|kegg}} | KEGG_Ref = {{keggcite|correct|kegg}}
| KEGG = D00506 | KEGG = D00506
| ChEBI_Ref = {{ebicite|changed|EBI}} | ChEBI_Ref = {{ebicite|correct|EBI}}
| ChEBI = 8069 | ChEBI = 8069
| ChEMBL_Ref = {{ebicite|correct|EBI}} | ChEMBL_Ref = {{ebicite|correct|EBI}}
| ChEMBL = 40 | ChEMBL = 40
| NIAID_ChemDB =

| PDB_ligand =
<!--Chemical data-->
| synonyms = <!-- Chemical and physical data -->
| C=12 | H=12 | N=2 | O=3
| IUPAC_name = 5-Ethyl-5-phenyl-1,3-diazinane-2,4,6-trione
| molecular_weight = 232.235 g/mol
| C = 12
| smiles = O=C1NC(=O)NC(=O)C1(c2ccccc2)CC
| H = 12
| InChI = 1/C12H12N2O3/c1-2-12(8-6-4-3-5-7-8)9(15)13-11(17)14-10(12)16/h3-7H,2H2,1H3,(H2,13,14,15,16,17)
| N = 2
| InChIKey = DDBREPKUVSBGFI-UHFFFAOYAB
| O = 3
| SMILES = O=C1NC(=O)NC(=O)C1(c2ccccc2)CC
| StdInChI_Ref = {{stdinchicite|correct|chemspider}} | StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| StdInChI = 1S/C12H12N2O3/c1-2-12(8-6-4-3-5-7-8)9(15)13-11(17)14-10(12)16/h3-7H,2H2,1H3,(H2,13,14,15,16,17) | StdInChI = 1S/C12H12N2O3/c1-2-12(8-6-4-3-5-7-8)9(15)13-11(17)14-10(12)16/h3-7H,2H2,1H3,(H2,13,14,15,16,17)
| StdInChI_comment =
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}} | StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
| StdInChIKey = DDBREPKUVSBGFI-UHFFFAOYSA-N | StdInChIKey = DDBREPKUVSBGFI-UHFFFAOYSA-N
| density =
| density_notes =
| melting_point =
| melting_high =
| melting_notes =
| boiling_point =
| boiling_notes =
| solubility =
| sol_units =
| specific_rotation =
}} }}

<!-- Definition and medical uses -->
'''Phenobarbital''', also known as '''phenobarbitone''' or '''phenobarb''', sold under the brand name '''Luminal''' among others, is a ] of the ] type.<ref name=AHFS2015 /> It is recommended by the ] (WHO) for the treatment of certain types of ] in ].<ref name=Ila2012>{{cite journal | vauthors = Ilangaratne NB, Mannakkara NN, Bell GS, Sander JW | title = Phenobarbital: missing in action | journal = Bulletin of the World Health Organization | volume = 90 | issue = 12 | pages = 871–871A | date = December 2012 | pmid = 23284189 | pmc = 3524964 | doi = 10.2471/BLT.12.113183 | doi-broken-date = 12 November 2024 }}</ref> In the developed world, it is commonly used to treat ]s in ],<ref>{{cite journal | vauthors = Brodie MJ, Kwan P | title = Current position of phenobarbital in epilepsy and its future | journal = Epilepsia | volume = 53 | issue = Suppl 8 | pages = 40–46 | date = December 2012 | pmid = 23205961 | doi = 10.1111/epi.12027 | s2cid = 25553143 | doi-access = free }}</ref> while other medications are generally used in older children and adults.<ref>{{cite web | author = National Clinical Guideline Centre (UK) | title = The Epilepsies: The Diagnosis and Management of the Epilepsies in Adults and Children in Primary and Secondary Care: Pharmacological Update of Clinical Guideline 20. | series = National Institute for Health and Clinical Excellence: Guidance | location = London | publisher = Royal College of Physicians (UK) | date = January 2012 | pmid = 25340221 | url = https://www.ncbi.nlm.nih.gov/books/NBK247130/ | via = PubMed | access-date = 30 October 2022 | archive-date = 8 November 2022 | archive-url = https://web.archive.org/web/20221108092313/https://www.ncbi.nlm.nih.gov/books/NBK247130/ | url-status = live }}</ref> It is also used for veterinary purposes.<ref name = Dewey>{{cite book| vauthors = Thomas WB| chapter = Seizures and narcolepsy| veditors = Dewey CW | title = A Practical Guide to Canine and Feline Neurology| publisher = Iowa State Press| location = Ames, Iowa| year = 2003| isbn = 978-0-8138-1249-6}}</ref>

It may be administered by slow ] (IV infusion), ] (IM), or ] (swallowed by mouth). ] is not recommended.<ref name="AHFS2015" /> The IV or IM (injectable forms) may be used to treat ] if other drugs fail to achieve satisfactory results.<ref name="AHFS2015" /> Phenobarbital is occasionally used to treat ], ], and ] (as well as withdrawal from certain other drugs in specific circumstances), and prior to surgery as an ] and to induce ].<ref name="AHFS2015">{{cite web|title=Phenobarbital|url=https://www.drugs.com/monograph/phenobarbital.html|publisher=The American Society of Health-System Pharmacists|access-date=14 August 2015|url-status=live|archive-url=https://web.archive.org/web/20150906225702/http://www.drugs.com/monograph/phenobarbital.html|archive-date=6 September 2015}}</ref> It usually begins working within five minutes when used intravenously and half an hour when administered orally.<ref name="AHFS2015" /> Its effects last for between four hours and two days.<ref name="AHFS2015" /><ref name="Marx2010">{{cite book| vauthors = Marx JA |title=Rosen's emergency medicine : concepts and clinical practice|date=2010|publisher=Mosby/Elsevier|location=Philadelphia|isbn=978-0-323-05472-0|page=1352|edition=7|url=https://books.google.com/books?id=u7TNcpCeqx8C&pg=PA1352|url-status=live|archive-url=https://web.archive.org/web/20160305025648/https://books.google.ca/books?id=u7TNcpCeqx8C&pg=PA1352|archive-date=5 March 2016}}</ref>

<!-- Side effects and mechanism -->
Potentially serious side effects include a ] and ].<ref name=AHFS2015 /> There is potential for both ] and ] following long-term use.<ref name=AHFS2015 /> It may also increase the risk of ].<ref name=AHFS2015 />

It is ] D in Australia, meaning that it may cause harm when taken during pregnancy.<ref name=AHFS2015 /><ref>{{cite web|title=Prescribing medicines in pregnancy database|url=http://www.tga.gov.au/hp/medicines-pregnancy.htm|work=Australian Government|access-date=22 April 2014|date=3 March 2014|url-status=live|archive-url=https://web.archive.org/web/20140408040902/http://www.tga.gov.au/hp/medicines-pregnancy.htm#.U1Yw8Bc3tqw|archive-date=8 April 2014}}</ref> If used during ] it may result in drowsiness in the baby.<ref>{{cite web|title=Phenobarbital use while Breastfeeding|url=https://www.drugs.com/breastfeeding/phenobarbital.html|access-date=14 August 2015|date=2013|url-status=live|archive-url=https://web.archive.org/web/20150908025935/http://www.drugs.com/breastfeeding/phenobarbital.html|archive-date=8 September 2015}}</ref> Phenobarbital works by increasing the activity of the inhibitory ] ].<ref name=AHFS2015 />

<!-- History, society and culture -->
Phenobarbital was discovered in 1912 and is the oldest still commonly used ].<ref>{{cite book | vauthors = Brenner GM, Stevens CW | chapter = Antiepileptic Drugs |title=Pharmacology |date=2013 |publisher= Elsevier/Saunders |location=Philadelphia, PA |isbn=978-1-4557-0278-7 |page=204 |edition=4th | chapter-url = https://books.google.com/books?id=Cd39SN6OBiMC&pg=PA204 |url-status=live |archive-url= https://web.archive.org/web/20170904150548/https://books.google.com/books?id=Cd39SN6OBiMC&pg=PA204 |archive-date=4 September 2017}}</ref><ref>{{cite book| vauthors = Engel J |title=Epilepsy : a comprehensive textbook|date=2008|publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-5777-5|page=1431|edition=2nd|url=https://books.google.com/books?id=3ZktoDp7tZoC&pg=PA1431|url-status=live|archive-url=https://web.archive.org/web/20160305041712/https://books.google.ca/books?id=3ZktoDp7tZoC&pg=PA1431|archive-date=5 March 2016}}</ref> It is on the ].<ref name="WHO23rd">{{cite book | vauthors = ((World Health Organization)) | title = The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023) | year = 2023 | hdl = 10665/371090 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | id = WHO/MHP/HPS/EML/2023.02 | hdl-access=free }}</ref>

== Medical uses ==
Phenobarbital is used in the treatment of all types of ]s, except ]s.<ref name="NICEguidelines2004">{{cite web| url = http://www.nice.org.uk/page.aspx?o=CG020NICEguideline| title = CG20 Epilepsy in adults and children: NICE guideline| access-date = 6 September 2006| author = NICE| author-link = National Institute for Health and Clinical Excellence| date = 27 October 2005| publisher = ]| url-status = dead| archive-url = https://web.archive.org/web/20061009090708/http://www.nice.org.uk/page.aspx?o=CG020NICEguideline| archive-date = 9 October 2006}}</ref><ref name="BNF51">] 51</ref> It is no less effective at seizure control than ], but phenobarbital is not as well tolerated.<ref>{{cite journal | vauthors = Nolan SJ, Tudur Smith C, Pulman J, Marson AG | title = Phenobarbitone versus phenytoin monotherapy for partial onset seizures and generalised onset tonic-clonic seizures | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD002217 | date = January 2013 | pmid = 23440786 | doi = 10.1002/14651858.CD002217.pub2 }}</ref> Phenobarbital may provide a clinical advantage over ] for treating ]. Carbamazepine may provide a clinical advantage over phenobarbital for ].<ref>{{cite journal | vauthors = Nevitt SJ, Marson AG, Tudur Smith C | title = Carbamazepine versus phenobarbitone monotherapy for epilepsy: an individual participant data review | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 10 | pages = CD001904 | date = October 2018 | pmid = 30353945 | pmc = 6517155 | doi = 10.1002/14651858.CD001904.pub4 }}</ref>

The first-line drugs for treatment of ] are ]s, such as ], ], ], or ]. If these fail, then ] may be used, with phenobarbital being an alternative in the US (favored in infants), but used only third-line in the UK.<ref name="BNFc4.8.2">{{cite book| title =British National Formulary for Children| chapter = 4.8.2 Drugs used in status epilepticus| author1 = ] | author2 = ] | author3 = ] and Neonatal and Paediatric Pharmacists Group| year= 2006| isbn = 978-0-85369-676-6| page = 269| publisher =BMJ Publishing| location =London| title-link = British National Formulary for Children}}</ref> Failing that, the only treatment is ] in ].<ref name="BNF51" /><ref name="Kalvaiainen2005">{{cite journal | vauthors = Kälviäinen R, Eriksson K, Parviainen I | title = Refractory generalised convulsive status epilepticus: a guide to treatment | journal = CNS Drugs | volume = 19 | issue = 9 | pages = 759–768 | year = 2005 | pmid = 16142991 | doi = 10.2165/00023210-200519090-00003 | s2cid = 11274515 }}</ref> The ] (WHO) gives phenobarbital a first-line recommendation in the developing world and it is commonly used there.<ref name="Ila2012" /><ref>{{cite book| vauthors = Michelucci R, Pasini E, Tassinari CA | pages = 585-603 (587) | chapter = Phenobarbital, Primidone and Other Barbiturates | veditors = Shorvon S, Perucca E, Engel Jr J |title=The treatment of epilepsy |year=2009 |publisher=Wiley-Blackwell |location=Chichester, UK|isbn=978-1-4443-1667-4 |chapter-url=https://books.google.com/books?id=rFFzFzZJtasC&pg=PA587|edition=3rd|url-status=live|archive-url=https://web.archive.org/web/20160521102931/https://books.google.com/books?id=rFFzFzZJtasC&pg=PA587|archive-date=21 May 2016}}</ref>

Phenobarbital is the first-line choice for the treatment of ]s.<ref name="pmid 34389261">{{cite journal | vauthors = Xu ZE, Li WB, Qiao MY, Cui HT, Zhao LZ, Chen QX, Miao JK | title = Comparative efficacy of anti-epileptic drugs for neonatal seizures: A network meta-analysis | journal = Pediatrics and Neonatology | volume = 62 | issue = 6 | pages = 598–605 | date = November 2021 | pmid = 34389261 | doi = 10.1016/j.pedneo.2021.06.005 | s2cid = 237010210 | doi-access = free }}</ref><ref name="BNFc4.8.1">{{cite book| title =British National Formulary for Children| chapter = 4.8.1 Control of epilepsy| pages = 255–6| author1 = ] | author2 = ] | author3 = ] | author4 = Neonatal and Paediatric Pharmacists Group| year= 2006| isbn = 978-0-85369-676-6| publisher =BMJ Publishing| location =London| title-link = British National Formulary for Children}}</ref><ref name="Scott1993Neonatal">{{cite book | vauthors = Pellock JM, Dodson WE, Bourgeois BF | title = Pediatric Epilepsy| date = 1 January 2001| publisher = Demos Medical Publishing| isbn = 978-1-888799-30-9| page = 152}}</ref><ref name="Sheth2005">{{cite web |url = http://www.emedicine.com/NEURO/topic240.htm |title = Neonatal Seizures |access-date = 6 September 2006 | vauthors = Sheth RD |date = 30 March 2005 |work = eMedicine |publisher = WebMD |url-status = live |archive-url = https://web.archive.org/web/20060709212952/http://www.emedicine.com/NEURO/topic240.htm |archive-date = 9 July 2006 }}</ref> Concerns that neonatal seizures in themselves could be harmful make most physicians treat them aggressively. No reliable evidence, though, supports this approach.<ref name="Booth2004">{{cite journal | vauthors = Booth D, Evans DJ | title = Anticonvulsants for neonates with seizures | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD004218 | date = October 2004 | pmid = 15495087 | doi = 10.1002/14651858.CD004218.pub2 | veditors = Booth D | s2cid = 29887880 }}</ref>

Phenobarbital is sometimes used for ] and ] for its ] and anti-convulsant properties. The benzodiazepines ] (Librium) and ] (Serax) have largely replaced phenobarbital for detoxification.<ref>{{cite journal | vauthors = Miller NS, Gold MS | title = Management of withdrawal syndromes and relapse prevention in drug and alcohol dependence | journal = American Family Physician | volume = 58 | issue = 1 | pages = 139–146 | date = July 1998 | pmid = 9672434 | url = http://www.aafp.org/afp/980700ap/miller.html | access-date = 31 March 2011 | url-status = live | archive-url = https://web.archive.org/web/20101228033819/http://www.aafp.org/afp/980700ap/miller.html | archive-date = 28 December 2010 }}</ref>

Phenobarbital is useful for ] and ].<ref>{{cite book| vauthors = Aschenbrenner DS, Venable SJ |title=Drug Therapy in Nursing|date=2009|publisher=Lippincott Williams & Wilkins|isbn=9780781765879|page= |url= https://archive.org/details/studyguidetoacco0000asch|url-access=registration |language=en}}</ref>

=== Other uses ===
Phenobarbital properties can effectively reduce tremors and seizures associated with abrupt withdrawal from benzodiazepines.

Phenobarbital is occasionally prescribed in low doses to aid in the conjugation of ] in people with ],<ref>{{cite book|title=Harrison's Principles of Internal Medicine | edition = 19th | vauthors = Kasper D |publisher=Mc Graw Hill|isbn=978-0071802154|pages=2002|quote=Bilirubin concentrations during phenobarbital administration do not return to normal but are typically in the range of 51-86 µmol/L (3-5 mg/dL). Although the incidence of kernicterus in CN-II is low, instances have occurred, not only in infants but also in adolescents and adults, often in the setting of an intercurrent illness, fasting, or another factor that temporarily raises the serum bilirubin concentration above baseline and reduces serum albumin levels. For this reason, phenobarbital therapy is highly recommended, a single bedtime dose often suffices to maintain clinically safe serum bilirubin concentrations.|date=8 April 2015}}</ref> or in people with ].<ref>{{cite journal |vauthors=Tamayo V, Del Valle Díaz S, Durañones Góngora S, Corina Domínguez Cardosa M, del Carmen Clares Pochet P |url=http://scielo.sld.cu/pdf/san/v16n12/san021612.pdf |title=Pruebas de laboratorio en el síndrome de Gilbert consecutivo a hepatitis |trans-title=Laboratory tests in Gilbert's syndrome after hepatitis |language=Spanish |journal=Medisan |date=December 2012 |volume=16 |issue=12 |pages=1823–1830 |access-date=30 October 2022 |archive-date=30 October 2022 |archive-url=https://web.archive.org/web/20221030102525/http://scielo.sld.cu/pdf/san/v16n12/san021612.pdf |url-status=live }}</ref> In infants suspected of neonatal ], phenobarbital is used in preparation for a <sup>99m</sup>Tc-IDA hepatobiliary (]; '''h'''epatobiliary <sup>99m</sup>Tc-'''i'''mino'''d'''iacetic '''a'''cid) study that differentiates atresia from ] or ].

In massive doses, phenobarbital is prescribed to terminally ill people to allow them to end their life through ].<ref>{{cite web |url=http://www.doh.wa.gov/portals/1/Documents/Pubs/422-109-DeathWithDignityAct2015.pdf |title=Washington State Department of Health 2015 Death with Dignity Act Report |access-date=7 June 2017 |url-status=live |archive-url=https://web.archive.org/web/20170215140943/http://www.doh.wa.gov/portals/1/Documents/Pubs/422-109-DeathWithDignityAct2015.pdf |archive-date=15 February 2017 }}</ref>

Like other barbiturates, phenobarbital ],<ref>{{cite journal | vauthors = López-Muñoz F, Ucha-Udabe R, Alamo C | title = The history of barbiturates a century after their clinical introduction | journal = Neuropsychiatric Disease and Treatment | volume = 1 | issue = 4 | pages = 329–343 | date = December 2005 | pmid = 18568113 | pmc = 2424120 | quote = Despite their widespread use during the first half of the 20th century, no barbiturate succeeded in eliminating the main drawbacks of these drugs, which were the phenomena of dependence and death by overdose }}</ref> but this is reported to be relatively infrequent.<ref>{{Cite web |url=https://books.google.com/books?id=fQSrJurXnDkC&q=phenobarbital+abuse |title=Barbiturate abuse in the United States, 1973 |date=1973 |access-date=14 March 2023 |archive-date=15 August 2024 |archive-url=https://web.archive.org/web/20240815060429/https://books.google.com/books?id=fQSrJurXnDkC&q=phenobarbital+abuse#v=snippet&q=phenobarbital%20abuse&f=false |url-status=live }}</ref>

The synthesis of a photoswitchable analog (DASA-barbital) and phenobarbital has been described for use as a research compound in ].<ref name=":1">{{cite journal | vauthors = Castagna R, Maleeva G, Pirovano D, Matera C, Gorostiza P | title = Donor-Acceptor Stenhouse Adduct Displaying Reversible Photoswitching in Water and Neuronal Activity | journal = Journal of the American Chemical Society | volume = 144 | issue = 34 | pages = 15595–15602 | date = August 2022 | pmid = 35976640 | doi = 10.1021/jacs.2c04920 | s2cid = 251623598 | hdl = 2434/918919 | hdl-access = free }}</ref>

== Side effects ==
Sedation and hypnosis are the principal side effects (occasionally, they are also the intended effects) of phenobarbital. ] effects, such as dizziness, ] and ], are also common. In elderly patients, it may cause excitement and confusion, while in children, it may result in ].<ref name=":0">{{Cite web|url=https://reference.medscape.com/drug/luminal-phenobarbital-343017|title=Phenobarbital dosing, indications, interactions, adverse effects, and more|website=reference.medscape.com|access-date=27 March 2019|archive-date=27 March 2019|archive-url=https://web.archive.org/web/20190327133331/https://reference.medscape.com/drug/luminal-phenobarbital-343017|url-status=live}}</ref>

Phenobarbital is a ] hepatic enzyme inducer. It binds transcription factor receptors that activate cytochrome P450 transcription, thereby increasing its amount and thus its activity.<ref>{{cite journal | vauthors = Brodie MJ, Mintzer S, Pack AM, Gidal BE, Vecht CJ, Schmidt D | title = Enzyme induction with antiepileptic drugs: cause for concern? | journal = Epilepsia | volume = 54 | issue = 1 | pages = 11–27 | date = January 2013 | pmid = 23016553 | doi = 10.1111/j.1528-1167.2012.03671.x | s2cid = 37595905 | doi-access = free }}</ref> Caution is to be used with children. Among anti-convulsant drugs, behavioural disturbances occur most frequently with ] and phenobarbital.<ref>{{cite journal | vauthors = Trimble MR, Cull C | title = Children of school age: the influence of antiepileptic drugs on behavior and intellect | journal = Epilepsia | volume = 29 | issue = Suppl 3 | pages = S15–S19 | year = 1988 | pmid = 3066616 | doi = 10.1111/j.1528-1157.1988.tb05805.x | s2cid = 20440040 }}</ref>

== Contraindications ==
], hypersensitivity to any barbiturate, prior dependence on barbiturates, severe ] (as with ]), severe ], pregnancy, and breastfeeding are contraindications for phenobarbital use.<ref name=":0" />

== Overdose ==
{{Main|Barbiturate overdose}}

Phenobarbital causes a depression of the body's systems, mainly the ] and ]s. Thus, the main characteristic of phenobarbital overdose is a "slowing" of bodily functions, including decreased ] (even ]), ], ], ], and ] (in massive overdoses). Overdose may also lead to ] and ] as a result of ] and can result in death.

The ] (EEG) of a person with phenobarbital overdose may show a marked decrease in electrical activity, to the point of mimicking ]. This is due to profound depression of the central nervous system and is usually reversible.<ref name="Habal">{{cite web| url = http://www.emedicine.com/MED/topic207.htm| title = Barbiturate Toxicity| access-date = 14 September 2006| vauthors = Habal R | date = 27 January 2006| work = eMedicine| publisher = WebMD| url-status = live| archive-url = https://web.archive.org/web/20080720013401/http://www.emedicine.com/med/topic207.htm| archive-date = 20 July 2008}}</ref>

Treatment of phenobarbital overdose is ], and mainly consists of the maintenance of ] patency (through ] and ]), correction of bradycardia and hypotension (with ] and ]s, if necessary), and removal of as much drug as possible from the body. In very large overdoses, multi-dose activated charcoal is a mainstay of treatment as the drug undergoes enterohepatic recirculation. Urine alkalization (achieved with sodium bicarbonate) enhances renal excretion. ] is effective in removing phenobarbital from the body and may reduce its half-life by up to 90%.<ref name="Habal" /> No specific antidote for barbiturate poisoning is available.<ref>{{cite web |url= https://www.nlm.nih.gov/medlineplus/ency/article/000951.htm |title= Barbiturate intoxication and overdose |access-date= 15 July 2008 |publisher= MedLine Plus |url-status= live |archive-url= https://web.archive.org/web/20081001212130/http://www.nlm.nih.gov/medlineplus/ency/article/000951.htm |archive-date= 1 October 2008 }}</ref>

== Mechanism of action ==
Phenobarbital acts as an ] which extends the amount of time the chloride ion channel is open by interacting with ] subunits. Through this action, phenobarbital increases the flow of ] ions into the neuron which decreases the excitability of the ]. ] this post-synaptic membrane leads to a decrease in the general excitatory aspects of the post-synaptic neuron. By making it harder to ] the neuron, the ] of the post-synaptic neuron will be increased.<ref>{{cite book|vauthors=Lewis CB, Adams N|chapter=Phenobarbital|date=2019|chapter-url=http://www.ncbi.nlm.nih.gov/books/NBK532277/|title=StatPearls|publisher=StatPearls Publishing|pmid=30335310|access-date=27 March 2019|archive-date=28 August 2021|archive-url=https://web.archive.org/web/20210828223229/https://www.ncbi.nlm.nih.gov/books/NBK532277/|url-status=live}}</ref>

Direct blockade of glutamatergic ] and ]s are also believed to contribute to the hypnotic/anticonvulsant effect that is observed with phenobarbital.<ref>{{cite book | vauthors = Brust JC | chapter = Alcohol and the nervous system – Chapter 8 – Acute withdrawal: diagnosis and treatment|date=2014| title = Handbook of Clinical Neurology |volume=125 |pages=123–131 |publisher=Elsevier |language=en|doi=10.1016/b978-0-444-62619-6.00008-2 |pmid=25307572 |isbn=9780444626196}}</ref><ref>{{cite journal | vauthors = Löscher W, Rogawski MA | title = How theories evolved concerning the mechanism of action of barbiturates | journal = Epilepsia | volume = 53 Suppl 8 | issue = s8 | pages = 12–25 | date = December 2012 | pmid = 23205959 | doi = 10.1111/epi.12025 }}</ref>

== Pharmacokinetics ==
Phenobarbital has an oral ] of about 90%. ]s (C<sub>max</sub>) are reached eight to 12 hours after oral administration. It is one of the longest-acting barbiturates available – it remains in the body for a very long time (half-life of two to seven days) and has very low ] (20 to 45%). Phenobarbital is metabolized by the liver, mainly through ] and ] and induces many ]s of the ]. Cytochrome P450 2B6 (]) is specifically induced by phenobarbital via the ]/] ] ]. It is excreted primarily by the ]s.<ref>{{cite book | vauthors = Flynn S, Babi MA |title=Pharmacology and Therapeutics for Dentistry |date=2017 |pages=176–192 |chapter=Chapter 12: Anticonvulsants |publisher=Elsevier |language=en |doi=10.1016/b978-0-323-39307-2.00012-6 |isbn=9780323393072 }}</ref>

== History ==
The first barbiturate drug, ], was synthesized in 1902 by German chemists ] and ] and was first marketed as Veronal by ]. By 1904, several related drugs, including phenobarbital, had been synthesized by Fischer. Phenobarbital was brought to market in 1912 by the drug company ] as the brand Luminal. It remained a commonly prescribed sedative and hypnotic until the introduction of ]s in the 1960s.<ref name="Sneader2005">{{cite book| vauthors = Sneader W | title = Drug Discovery| date= 23 June 2005| publisher = John Wiley and Sons| isbn = 978-0-471-89979-2| page = 369}}</ref>

Phenobarbital's soporific, sedative and hypnotic properties were well known in 1912, but it was not yet known to be an effective anti-convulsant. The young doctor ]<ref>{{cite web |url = http://www.whonamedit.com/doctor.cfm/2764.html |title = Alfred Hauptmann |access-date = 6 September 2006 | vauthors = Enersen OD |url-status = live |archive-url = https://web.archive.org/web/20061109210437/http://www.whonamedit.com/doctor.cfm/2764.html |archive-date = 9 November 2006 }}</ref> gave it to his epilepsy patients as a ] and discovered their seizures were susceptible to the drug. Hauptmann performed a careful study of his patients over an extended period. Most of these patients were using the only effective drug then available, ], which had terrible side effects and limited efficacy. On phenobarbital, their epilepsy was much improved: The worst{{unclear-inline|date=July 2022}} patients had fewer and lighter seizures and some patients became seizure-free. In addition, they improved physically and mentally as bromides were removed from their regimen. Patients who had been institutionalised due to the severity of their epilepsy were able to leave and, in some cases, resume employment. Hauptmann dismissed concerns that its effectiveness in stalling seizures could lead to patients developing a build-up that needed to be "discharged". As he expected, withdrawal of the drug led to an increase in seizure frequency – it was not a cure. The drug was quickly adopted as the first widely effective anti-convulsant, though ] delayed its introduction in the U.S.<ref name="Scott1993">{{cite book| vauthors = Scott DF | title = The History of Epileptic Therapy| date = 15 February 1993| publisher = Taylor & Francis| isbn = 978-1-85070-391-4| pages = 59–65}}</ref>

In 1939, a German family asked ] to have their disabled son killed; the five-month-old boy was given a lethal dose of Luminal after Hitler sent his own doctor to examine him. A few days later 15 psychiatrists were summoned to Hitler's Chancellery and directed to commence a clandestine program of ].<ref>{{cite news| vauthors = Zoech I |title=Named: the baby boy who was Nazis' first euthanasia victim |url=https://www.telegraph.co.uk/news/worldnews/europe/germany/1443967/Named-the-baby-boy-who-was-Nazis-first-euthanasia-victim.html |access-date=1 November 2013|newspaper=The Telegraph|date=12 October 2003|quote=The case was to provide the rationale for a secret Nazi decree that led to 'mercy killings' of almost 300,000 mentally and physically handicapped people. The Kretschmars wanted their son dead but most of the other children were forcibly taken from their parents to be killed.|url-status=live|archive-url=https://web.archive.org/web/20131216194326/http://www.telegraph.co.uk/news/worldnews/europe/germany/1443967/Named-the-baby-boy-who-was-Nazis-first-euthanasia-victim.html|archive-date=16 December 2013}}</ref><ref>{{cite news|title=Killing Babies, Compassionately|url=http://www.weeklystandard.com/Content/Public/Articles/000/000/012/003dncoj.asp|access-date=1 November 2013|newspaper=Weekly Standard|date=26 March 2006| vauthors = Smith WJ |quote=Hitler later signed a secret decree permitting the euthanasia of disabled infants. Sympathetic physicians and nurses from around the country--many not even Nazi party members--cooperated in the horror that followed. Formal 'protective guidelines' were created, including the creation of a panel of 'expert referees,' which judged which infants were eligible for the program.|archive-url=https://web.archive.org/web/20131103222928/http://www.weeklystandard.com/Content/Public/Articles/000/000/012/003dncoj.asp|archive-date=3 November 2013|url-status=dead}}</ref>

In 1940, at a clinic in ], Germany, around 50 intellectually disabled children were injected with Luminal and killed that way. A plaque was erected in their memory in 1988 in the local hospital at Feuchtwanger&nbsp;Strasse 38, although a newer plaque does not mention that patients were killed using barbiturates on site.<ref>{{cite web| vauthors = Kaelber L |title=Kinderfachabteilung Ansbach |url=http://www.uvm.edu/~lkaelber/children/ansbach/ansbach.html |work=Sites of Nazi "Children's 'Euthanasia'" Crimes and Their Commemoration in Europe|publisher=University of Vermont|access-date=1 November 2013|date=8 March 2013|quote=In the late 1980s, important developments occurred at the clinic that led to the first publication on the subject and the display of two plaques. Dr. Reiner Weisenseel wrote his dissertation under Dr. Athen, then the director of the Ansbacher Bezirkskrankenhaus, on the involvement of the clinic in Euthanasia crimes, including the operation of the Kinderfachabteilung. In 1988 two members of the Green Party as well as the regional diet (Bezirkstag) were horrified to find portraits of physicians involved in Nazi euthanasia crimes among the honorary display of medical personnel in the administrative building, and they successfully petitioned to have these portraits removed. Since 1992 a plaque hangs in the entry hallway of the administrative building. It reads: 'In the Third Reich the Ansbach facility delivered to their death more than 2000 of the patients entrusted to it as life unworthy of living: They were transferred to killing facilities or starved to death. In their own way, many people incurred responsibility.' It continues: 'Half a century later full of shame we commemorate the victims and call to remember the Fifth Commandment.' The killing of children ''specifically transferred to the clinic to be murdered'' is not noted. The plaque does not address that that euthanasia victims were not only starved or transported to gassing facilities but killed using barbiturates on site.|url-status=live|archive-url=https://web.archive.org/web/20131103075613/http://www.uvm.edu/~lkaelber/children/ansbach/ansbach.html|archive-date=3 November 2013}}</ref><ref>{{cite web | vauthors = Binder J | title = Die Heil- und Pflegeanstalt Ansbach während des Nationalsozialismus | url = http://www.bezirksklinikum-ansbach.de/fileadmin/user_upload/bilder/Ansbach/BklMfr_Flyer_61_AN_Gedenkorte_DRUCK_neu.pdf | work = Bezirksklinikum Ansbach | publisher = Bezirkskliniken Mittelfranken | access-date = 1 November 2013 | language = de | date = October 2011 | url-status = dead | archive-url = https://web.archive.org/web/20131103130325/http://www.bezirksklinikum-ansbach.de/fileadmin/user_upload/bilder/Ansbach/BklMfr_Flyer_61_AN_Gedenkorte_DRUCK_neu.pdf | archive-date = 3 November 2013 }}</ref> Luminal was used in the Nazi ] until at least 1943.<ref>{{cite web| vauthors = Kaelber L |title=Jewish Children with Disabilities and Nazi "Euthanasia" Crimes|url=http://www.uvm.edu/~lkaelber/children/leipzigdoesen/bull2013-Kaelber1.pdf|work=The Bulletin of the Carolyn and Leonard Miller Center for Holocaust Studies|publisher=University of Vermont|access-date=1 November 2013|date=Spring 2013|quote=Two Polish physicians reported at the time that 235 children from ages up to 14 were listed in the booklet, of whom 221 had died. An investigation revealed that the medical records of the children had been falsified, as those records showed a far lower dosage of Luminal given to them than was entered into the Luminal booklet. For example, the medical records for Marianna N. showed for 16 January 1943 (she died on that day) a dosage of 0.1 g of Luminal, whereas the Luminal booklet showed the actual dosage as 0.4 g, or four times the dosage recommended for her body weight.|url-status=live|archive-url=https://web.archive.org/web/20131103080046/http://www.uvm.edu/~lkaelber/children/leipzigdoesen/bull2013-Kaelber1.pdf|archive-date=3 November 2013}}</ref><ref>{{cite journal | vauthors = López-Muñoz F, Alamo C, García-García P, Molina JD, Rubio G | title = The role of psychopharmacology in the medical abuses of the Third Reich: from euthanasia programmes to human experimentation | journal = Brain Research Bulletin | volume = 77 | issue = 6 | pages = 388–403 | date = December 2008 | pmid = 18848972 | doi = 10.1016/j.brainresbull.2008.09.002 | s2cid = 39858807 }}</ref>

Phenobarbital was used to treat ] by increasing liver metabolism and thus lowering ] levels. In the 1950s, ] was discovered, and became the standard treatment.<ref name="Pepling2005">{{cite journal| vauthors = Pepling RS| date = June 2005| title = Phenobarbital| journal = Chemical and Engineering News| volume = 83| issue = 25| url = http://pubs.acs.org/cen/coverstory/83/8325/8325phenobarbital.html| access-date = 6 September 2006| archive-date = 26 November 2005| archive-url = https://web.archive.org/web/20051126221741/http://pubs.acs.org/cen/coverstory/83/8325/8325phenobarbital.html| url-status = live}}</ref>

Phenobarbital was used for over 25 years as ] in the treatment of ]s.<ref name="Scott1993Febrile">{{cite book | vauthors = Pellock JM, Dodson WE, Bourgeois BF | title = Pediatric Epilepsy| date = 1 January 2001| publisher = Demos Medical Publishing| isbn = 978-1-888799-30-9| page = 169}}</ref> Although an effective treatment in preventing recurrent febrile seizures, it had no positive effect on patient outcome or risk of developing epilepsy. The treatment of simple febrile seizures with anticonvulsant prophylaxis is no longer recommended.<ref name="Baumann2005">{{cite web |url= http://www.emedicine.com/neuro/topic134.htm |title= Febrile Seizures |access-date = 6 September 2006 | vauthors = Baumann R |date= 14 February 2005 |work = eMedicine |publisher= WebMD |archive-url = https://web.archive.org/web/20060906023934/http://www.emedicine.com/NEURO/topic134.htm |archive-date = 6 September 2006 }}</ref><ref name="SIGN81">{{cite web |url = http://www.sign.ac.uk/pdf/sign81.pdf |title = Diagnosis and management of epilepsies in children and young people |access-date = 7 September 2006 |author = various |date = March 2005 |publisher = Scottish Intercollegiate Guidelines Network |pages = 15 |archive-url = https://web.archive.org/web/20060610140906/http://www.sign.ac.uk/pdf/sign81.pdf |archive-date = 10 June 2006 }}</ref>

==Society and culture==
=== Names ===
Phenobarbital is the ] and phenobarbitone is the ].

=== Synthesis ===
]
] drugs are obtained via ]s between a ] of ] and ] in the presence of a strong ].<ref name=Vogel>{{cite book| vauthors = Furniss B, Hannaford A, Smith P, Tatchell A |title=Vogel's Textbook of Practical Organic Chemistry | edition = 5th |year=1996|publisher=Longman Science & Technical|location=London|isbn=978-0-582-46236-6|pages=–1179|url=https://archive.org/details/TextbookOfPracticalOrganicChemistry5thEd|url-status=live|archive-url=https://web.archive.org/web/20160311011821/https://archive.org/details/TextbookOfPracticalOrganicChemistry5thEd|archive-date=11 March 2016}}</ref> The synthesis of phenobarbital uses this common approach as well but differs in the way in which this ] derivative is obtained. The reason for this difference is because ]s do not typically undergo ] in ] in the same way as ] ]s or ]s do.<ref>{{cite book| vauthors = Adams R |title=Organic Reactions, Volume 9|date=1957|publisher=John Wiley & Sons, Inc.|location=New York|isbn=978-0-471-00726-5|url=http://www.wiley.com/WileyCDA/WileyTitle/productCd-0471007269.html|access-date=18 July 2014|url-status=live|archive-url=https://web.archive.org/web/20141031013218/http://www.wiley.com/WileyCDA/WileyTitle/productCd-0471007269.html|archive-date=31 October 2014}}</ref> To overcome this lack of ] two dominant synthetic approaches using ] as a starting material have been developed:

The first of these methods consists of a ] of benzyl cyanide, giving ] ethyl ester.<ref>{{cite journal| vauthors = Adams R, Thal AF |title=Ethyl Phenylacetate|journal=Organic Syntheses |date=1922 |volume=2 |page=27 |doi=10.15227/orgsyn.002.0027 }}</ref> Subsequently, this ester undergoes cross ] using ], giving diethyl ester of phenyloxobutandioic acid. Upon heating this intermediate easily loses ], yielding ].<ref>{{cite journal| vauthors = Meyer GM, Levene PA |title=Diethyl phenylmalonate|journal=Organic Syntheses |date=1936 |volume=16 |page=33 |doi=10.15227/orgsyn.016.0033}}</ref> ] using ] leads to the formation of α-phenyl-α-ethylmalonic ester. Finally, a ] with ] gives phenobarbital.<ref name=Vogel />

]

The second approach utilizes ] in the presence of a strong base to give α-phenylcyanoacetic ester.<ref name=NitrileMethod>{{cite journal| vauthors = Chamberlain JS, Chap JJ, Doyle JE, Spaulding LB |title=The Synthesis of 5,5-Alkylphenylbarbituric Acids|journal=Journal of the American Chemical Society|date=1935|volume=57|issue=2|pages=352–354|doi=10.1021/ja01305a036}}</ref><ref>{{cite journal| vauthors = Nelson WL, Cretcher LH |title=The Preparation of Ethyl Phenylmalonate and of 5-Phenyl-beta-hydroxyethylbarbituric acid|journal=Journal of the American Chemical Society|date=1928|volume=50|issue=10|pages=2758–2762 |doi=10.1021/ja01397a029}}</ref> Alkylation of this ester using ethyl bromide proceeds via a ] intermediate to give the α-phenyl-α-ethylcyanoacetic ester.<ref>{{cite journal| vauthors = Makosza M, Jończyk A |title=Phase-Transfer Alkylation of Nitriles: 2-Phenylbutyronitrile|journal=Organic Syntheses|date=1976|volume=55|page=91|doi=10.15227/orgsyn.055.0091}}</ref> This product is then further converted into the 4-iminoderivative upon condensation with urea. Finally acidic ] of the resulting product gives phenobarbital.<ref>{{cite patent | inventor = Inman MT, Bilter WP |title=Preparation of Phenobarbital | country = US | number = 2358072 | gdate = 12 September 1944 | assign1 = Kay Fries Chemicals, Inc. | postscript = . }}</ref>

]

A new synthetic route based on diethyl 2-ethyl-2-phenylmalonate and urea has been described.<ref name=":1" />

===Regulation===
The level of regulation includes ] non-narcotic (depressant) (] 2285) in the United States under the Controlled Substances Act 1970—but along with a few other barbiturates and at least one ], and ], ], or ] at low concentrations, it also has exempt prescription and had at least one exempt OTC combination drug now more tightly regulated for its ] content.<ref>{{cite web |url=http://www.deadiversion.usdoj.gov/schedules/orangebook/c_cs_alpha.pdf |title=DEA Diversion Control Division |access-date=13 April 2016 |url-status=live |archive-url=https://web.archive.org/web/20160417085659/http://www.deadiversion.usdoj.gov/schedules/orangebook/c_cs_alpha.pdf |archive-date=17 April 2016 }} pp 12 printed PDF 23.I.2016</ref> The phenobarbitone/phenobarbital exists in subtherapeutic doses which add up to an effective dose to counter the overstimulation and possible seizures from a deliberate overdose in ephedrine tablets for ], which are now regulated at the federal and state level as: a restricted OTC medicine and/or watched precursor, uncontrolled but watched/restricted prescription drug & watched precursor, a Schedule II, III, IV, or V prescription-only controlled substance & watched precursor, or a ] (which also has possible regulations at the county/parish, town, city, or district as well aside from the fact that the pharmacist can also choose not to sell it, and photo ID and signing a register is required) exempt Non-Narcotic restricted/watched OTC medicine.<ref>{{cite web |url=http://www.deadiversion.usdoj.gov/schedules/orangebook/c_cs_alpha.pdf |title=DEA Diversion Control Division |access-date=13 April 2016 |url-status=live |archive-url=https://web.archive.org/web/20160417085659/http://www.deadiversion.usdoj.gov/schedules/orangebook/c_cs_alpha.pdf |archive-date=17 April 2016 }} page 1,7, 12, accessed 23.I.2016</ref>

===Selected overdoses===
A mysterious woman, known as the ], was found dead in ], Norway, on 29 November 1970. Her death was caused by some combination of burns, phenobarbital, and ] poisoning; many theories about her death have been posited, and it is believed that she may have been a ].<ref>{{cite news |vauthors=Cheung H |title=The mystery death haunting Norway for 46 years |url=https://www.bbc.com/news/world-europe-39369429 |access-date=18 June 2019 |date=13 May 2017 |work=BBC News |archive-date=7 June 2019 |archive-url=https://web.archive.org/web/20190607195959/https://www.bbc.com/news/world-europe-39369429 |url-status=live }}</ref>

British veterinarian ], better known as the character Siegfried Farnon in the "All Creatures Great and Small" book series by ], committed suicide at the age of 84 by injecting himself with an overdose of phenobarbital. Activist ] also committed suicide by consuming phenobarbital, combined with ], on 12 April 1989; the residue of around 150 pills was found in his body at autopsy.<ref>{{cite news | title = Abbie Hoffman Committed Suicide Using Barbiturates, Autopsy Shows | vauthors = King W | date = 19 April 1989 | work = ] | url = https://query.nytimes.com/gst/fullpage.html?sec=health&res=950DE7D61F38F93AA25757C0A96F948260 | access-date = 9 April 2008 | url-status = live | archive-url = https://web.archive.org/web/20071016124522/http://query.nytimes.com/gst/fullpage.html?sec=health&res=950DE7D61F38F93AA25757C0A96F948260 | archive-date = 16 October 2007 }}</ref>

Thirty-nine members of the ] UFO cult committed mass suicide in March 1997 by drinking a lethal dose of phenobarbital and vodka "and then lay down to die" hoping to enter an alien spacecraft.<ref>{{cite web |url=http://www.history.com/this-day-in-history/heavens-gate-cult-members-found-dead |title=Heaven's Gate cult members found dead |work=History Channel |access-date=17 September 2014 |url-status=live |archive-url=https://web.archive.org/web/20141026204231/http://www.history.com/this-day-in-history/heavens-gate-cult-members-found-dead |archive-date=26 October 2014 }}</ref>

== Veterinary uses ==
Phenobarbital is one of the first-line drugs of choice to treat ] in ]s, as well as ]s.<ref name = Dewey/>

It is also used to treat ] in cats when anti-obsessional therapies prove ineffective.<ref>{{cite web | vauthors = Dodman N |title = Feline Hyperesthesia (FHS) |publisher = PetPlace.com |url = http://www.petplace.com/cats/feline-hyperesthesia/page1.aspx |access-date = 17 November 2011 |url-status = live |archive-url = https://web.archive.org/web/20111123162526/http://www.petplace.com/cats/feline-hyperesthesia/page1.aspx |archive-date = 23 November 2011 }}</ref>

It may also be used to treat seizures in ]s when ] treatment has failed or is contraindicated.<ref name = MVM>{{cite book| veditors = Kahn CM, Line S, Aiello SE | title= The Merck Veterinary Manual| date= 8 February 2005| publisher= ]| edition= 9th| isbn= 978-0-911910-50-6 | title-link= Merck Veterinary Manual}}</ref>

== References ==
{{Reflist}}

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