We describe, the first case of phenobarbital-induced DRESS syndrome presenting as a lichenoid eruption.A 49-year-old man had received phenobarbital for a cerebral metastasis. Twenty-five days later, he developed a purplish skin eruption, odynophagia, oral mucosal erosion and fever. Physical examination revealed a cervical lymphadenopathy and facial edema associated to a diffuse violaceous maculo-papular itchy rash. Laboratory findings showed a 1200/mm3 eosinophil’s cell count. Alanine aminotransferase was 169 IU/l. Lactate dehydrogenase and creatinine phosphokinase were at 768 and 90 IU/l, respectively. All symptoms resolved completely five weeks after phenobarbital withdrawal. Few days later, the patient died because of a cardio-respiratory arrest.

Objectives: Phenobarbital (PB) is the most widely used antiepileptic drug in the world, but its possible deleterious cognitive and behavioral side effects remain and important concern among physicians and patients. We attempt to investigate whether discontinuation of PB in epileptic children was accompanied by improvement in cognitive function.Design and methods: Evaluation of neuropsychiatric performance was performed by Wechsler intelligence Scale for Children-Revised (WISC-R), in 2 consecutive periods of 7 months interval, in 2 groups of epileptic children between 6-12 years old who were seizure free for at least 2 year and who were taking only PB as antiepileptic drug. The case group consisted of 24 patients for whom PB was discontinued and the control group consisted of 21 children who continued to take PB.Results: Results indicated that discontinuation of PB improved total IQ scored compared to control group (p=0.027), and this increase was mostly in performance (nonverbal) items while verbal items remained almost unchanged.Conclusion: These findings suggest that PB affects cognitive function; and the performance (nonverbal) deficits are reversible after therapy discontinuation.

The ever-increasing sensitivity of humans and living in a world full of stress and anxiety have led to the increased consumption of painkillers and sleeping pills. Barbiturates, which are among the most important sedatives, are regularly used by ordinary people. Addiction, suicide, and accidental deaths from inappropriate use of these drugs have been a subject of constant concern in medicine [1, 2]. Phenobarbital was the first effective antiepileptic drug introduced in 1912 [3]. It is a barbiturate that slows down the activities of the brain and nervous system and is used as a sedative in the treatment or prevention of seizures and in short-term therapies. Phenobarbital is used in all types of absence epilepsy and continuous epileptic seizures. Injectable phenobarbital is used for the emergency treatment of some acute seizures, including the attacks with eclampsia, meningitis, and toxic reactions to strychnine. It is also used for the prevention and treatment of febrile seizures [4]...

Phenobarbital is still one of the most commonly used medical treatments for different types of seizures. It has numerous different side-effects. Antiepileptic hypersensitivity syndrome (AHS) is a rare and potentially life-threatening adverse reaction to aromatic anticonvulsants such as phenobarbital. Its characteristic features are fever, rash, and lymphadenopathy with different severity of hematologic abnormalities. This case report presents a 26-month-old girl that developed fever, disseminated maculopapular rash, petechiae and thrombocytopenia two weeks after the initiation of phenobarbital prescribed for febrile seizure prophylaxis. The patient was admitted in our center with the impression of hypersensitivity syndrome, so phenobarbital was discontinued and her treatment was resumed with methylprednisolone and intravenous immunoglobulin. After a few days, all symptoms improved and the platelet count was normalized. Thrombocytopenia is a rare complication of hypersensitivity syndrome to phenobarbital in children. Paying attention to this point can prevent the life-threatening adverse effects of this highly consumed medicine.

A simple, rapid and accurate spectrophotometric method is proposed to determine Phenobarbital (PHB) based on the coupling of 2,6-Dichloroindophenol sodium salt hydrate (DSH) with PHB to give a new ligand which reacts with gold nanoparticles in alkaline medium at (30-40oC) to give an intense blue-green colored chelate complex having maximum absorption at 600nm. The optimization of the experimental conditions is described. Beer’s Law is obeyed at concentration range up to 5-45μg/ml with molar absorptivity 2368.797 L/mol.cm, Sandell's index was 0.09803 (μg/cm2) The correlation coefficient, limit of detection and limit of quantification were 0.9984, 1.3002μg/ml and 4.3342μg/ml, respectively. The method has been successfully used to determine the Phenobarbital concentration in pharmaceutical preparation.