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KMID : 0370220180620010049
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Yakhak Hoeji
2018 Volume.62 No. 1 p.49 ~ p.53
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Phenobarbital Dosing and Therapeutic Drug Monitoring in the Neonatal Intensive Care Unit
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Choi Dong-Wook
Ye Kyong-Nam
Kim Jung-Tae
An Sook-Hee
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Abstract
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Phenobarbital is an anticonvulsant used for the treatment of neonatal seizure. Large inter-individual differences in the pharmacokinetics of phenobarbital required therapeutic drug monitoring (TDM). This study aimed to investigate the TDM practices of phenobarbital in the neonatal intensive care unit (NICU) and suggest the appropriate dosing and monitoring guidelines of phenobarbital for critically ill neonates. A single-center, retrospective chart review included NICU patients with a TDM consult of phenobarbital by a pharmacist and at least 1 serum concentration obtained. A total 79 drug concentration values for 28 patients were included in the analysis. The percentage of phenobarbital concentrations within the therapeutic range (15-40 mg/L) was 65.8%. Sub-therapeutic levels (＜ 15 mg/L) were observed in 25 instances (31.6%). The percentage of concentrations within therapeutic range was significantly lower in preterm infants (52.9%) than in term infants (75.6%, p=0.024). Oral administration resulted in a significantly higher percentage of sub-therapeutic concentrations than intravenous administration (57.7% versus 18.9%, p=0.002). Patients with oral and intravenous administration received maintenance doses 3.5±1.1 and 3.9±1.1 mg/kg/day, respectively (p=0.114). The percentage of cases requiring dosage adjustment by a pharmacist was 41.8%. The rate of acceptance of pharmacist`s recommendations by physicians was 87.3%. For effective and safe treatment of phenobarbital in NICU patients, close monitoring is essential for preterm infants and the development of optimal dosing guideline for oral administration is required.
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KEYWORD
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neonate, phenobarbital, therapeutic drug monitoring
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