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NEUROLOGY 1981;31:1107
© 1981 American Academy of Neurology

Phenobarbital and phenytoin in neonatal seizures

Metabolism and tissue distribution

M. J. Painter, M.D., C. Pippenger, Ph.D., C. Wasterlain, M.D., M. Barmada, M.D., W. Pitlick, Ph.D., G. Carter, M.D. and S. Abern, M.D.

Departments of Neurology, Pediatrics, and Pathology (Drs. Barmada, Pitlick, Carter, and Abern), University of Pittsburgh School of Medicine, and Magee Women's Hospital (Dr. Painter), Pittsburgh, PA, the Department of Neurology (Dr. Pippenger), Columbia University, New York, NY, and Sepulveda Veterans Hospital and the Department of Neurology (Dr. Wasterlain), UCLA School of Medicine, Los Angeles, CA.

Loading doses of 15 to 20 mg per kilogram of both phenobarbital and phenytoin, administered intravenously, are necessary in the newborn to achieve rapid therapeutic plasma anticonvulsant levels. Maintenance doses of 3 to 4 mg per kilogram of both agents will maintain therapeutic levels. Phenytoin is, however, not predictably absorbed by the oral route.

Brain: plasma ratios were 0.71 2 0.21 for phenobarbital and 1.28 ± 0.32 for phenytoin, which are in general agreement with reported adult values. The brain: plasma ratio of phenobarbital increased with gestational age. Phenytoin was found in higher concentration in gray matter, whereas phenobarbital was equally distributed between gray and white matter.

Address correspondence and reprint requests to Dr. Painter. Magee Women's Hospital. Forbes and Halket Streets, Pittsburgh, PA 15213

Presented in part at the twenty-ninth annual meeting of the American Academy of Neurology, Atlanta, GA. April 1977, and at the thirty-first annual meeting of the Academy, Chicago, IL, April 1979.

Accepted for publication November 20, 1980.




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