Abstract
Phenobarbital has long been the drug of choice in controlling seizures and narcotic abstinence syndrome (NAS) in newborns. This report describes the relationship between dosage and serum concentration using a high oral loading dose of phenobarbital followed by maintenance dosing to provide therapeutic serum levels more rapidly than with previous methods. Twenty neonates born to narcotic dependent mothers were studied; all had NAS and were evaluated by an abstinence scoring system. When high abstinence scores were reported (>8), all received a loading dose of 16 mg/kg of phenobarbital orally to rapidly achieve an expected therapeutic serum level of 18 mcg/ml. Results showed a serum level of 16 mcg/ml ± 2.6 at 3 hours after the loading dose as determined by the EMIT technique. Serum levels (mcg/ml) at 12 and 24 hours after the loading dose were 18.9 ± 3 and 18.6 ± 3.4. If the infant responded with the expected therapeutic serum level, and if the abstinence score decreased to <8 (defined as control of symptoms), maintenance doses were begun. Daily maintenance dosing of 2 mg/kg/day allowed serum levels to decline at a desirable rate of 20% per day. These infants were more easily controlled and detoxified with the phenobarbital loading dose method than with previously accepted dosing regimens. Supported by NIDA Grant #DA01807 and Commonwealth of Pa. Contract #1674.
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