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    Suggest medication to manage reactions while weaning off Phenobarbital

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Posted on Thu, 11 May 2017 in Mental Health
Question: OK ...what benzo is safest (and dose) to rapidly reduce a patient off 224 mgs of phenobarbital due to adverse reactions
doctor
Answered by Dr. Ashok Kumar 1 hour later
Brief Answer:
Lorazepam can be considered

Detailed Answer:
Hello,
Thanks for using Healthcaremagic.

I read your query and understand your concerns.

Considering high GGT level and long term use of barbiturates it will be appropriate to consider use of lorazepam in dose range of 6-8 mg per day.

This particular benzo is not metabolized by liver (do not affect GGT) and highly effective in seizure disorders.

I hope this helps you.
Write back to me if you have more questions.
Thanks and regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ashok Kumar 13 minutes later
Thank you so stopping the phenobarbital cold turkey at 224 mgs ...the conversion factor is more like 12/14 mgs ....we have been using 8 mgs but it is not covering nearly all the physical symptoms (although remains seizure free, the patient also has trigeminal neuralgia (to which every drug has been tried to treat), with Brand Klonopin (no generics) per Mayo Clinic but getting him back there appears to be problematic given the same CYP450 enzymes are used and GGT OF 147 ...no alcohol or history of substance abuse. So goal 1 is to get the phenobarbital out as quickly as possible?
doctor
Answered by Dr. Ashok Kumar 14 hours later
Brief Answer:
Follow up

Detailed Answer:
Hello,
Thanks for reverting back to me.

Considering the fact that he is seizure free with 8 mg of lorazepam I feel he should be continued at the same dose.

I understand that conversion factor indicates high but there is increased metabolism of self with prolonged use of phenobarbitone and we need to consider that part.

In addition there is high possibility that additional symptoms of phenobarbitone withdrawal will be under control in few weeks if not days.

In case we go for 14 mg or like, we may get more side effects related to benzos.

Considering GGT of 147 I do not think we can go for clonazepam.

I hope this clarifies further.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Ashok Kumar

Psychiatrist

Practicing since :2000

Answered : 3157 Questions

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