Is there a role for phenobarbital in palliative care: A systematic review

Abstract

Introduction: Seizures are seen in 13% of cases in palliative care. Phenobarbital is a drug from the barbiturates’ family most used for its anticonvulsant and sedative properties, and therefore the drug of choice in palliative care suitable for the management of seizures and agitation. The study aimed to evaluate the role of phenobarbital in palliative care settings. Methods: A systematic literature review was conducted using predetermined keywords. Data was compiled and inclusion and exclusion criteria were established concerning the role of phenobarbital in palliative care. Five case studies met these criteria and were evaluated. Retrospective analysis of the data in the studies, along with randomized clinical trial about the use of at the end of life were reviewed by two independent reviewers. Results: Results of this review showed that phenobarbital is efficacious in the management of seizures and agitation, can be easily administered via different routes and utilized in various palliative care settings. No serious adverse skin reactions were noted with the use of phenobarbital and it did not abruptly end a patient’s life when used at appropriate doses. Conclusions: Although phenobarbital is an old drug and is an approved anticonvulsant, its sedating properties make it to be useful not only for seizure management, but also in patients experiencing agitation, physical and psychological distress, and restlessness. More studies are warranted in the sole practice of using phenobarbital and further explore its role in palliative care.