Interactions between phenobarbital and other drugs usually involve induction of the hepatic CYPs by phenobarbital (see Table 19-2). Concentrations of phenobarbital in plasma may be elevated by up to 40% during concurrent administration of valproic acid (see below).
THERAPEUTIC USES Phenobarbital is an effective drug for generalized tonic-clonic and partial seizures. It is efficacious, inexpensive, and has low toxicity. However, its sedative effects and its tendency to disturb behavior in children have reduced its use.
Mephobarbital (mebaral) is N-methylphenobarbital. It is N-demethylated in the liver, and most of its activity during long-term therapy results from the accumulation of phenobarbital. Consequently, the pharmacological properties, toxicity, and clinical uses of mephobarbital are the same as those for phenobarbital.
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