The precise mechanism of action for phenobarbital for the treatment of neonatal seizures is not fully understood, but it is thought to involve potentiation of synaptic inhibition through an action on the GABAA receptor.

SEZABY is a barbiturate indicated for the treatment of neonatal seizures in term and preterm infants.

Loading Dose (IV over 15 minutes):

• First dose: 20 mg/kg

• Second dose (≥15 min after first dose, if needed):

  • Term infants: 20 mg/kg

  • Preterm infants: 10–20 mg/kg

Maximum total loading dose: 40 mg/kg

Maintenance Dose (start 8–12 hours after loading):

• 1.5 mg/kg every 8 hours OR

• 2.25 mg/kg every 12 hours

• Continue for up to 5 days

Most Common (≥5%):

• Respiratory abnormalities (25%)

• Sedation (16%)

• Feeding disorder (16%)

• Hypotension (16%)

Acute porphyrias

Hypersensitivity to phenobarbital or other barbiturates

Profound sedation, respiratory depression, coma, death with opioid co-use

Dependence and withdrawal if used longer than recommended

Abuse, misuse, addiction in adolescents/adults (unapproved use)

Other Key Warnings:

• QT prolongation: Avoid in patients at risk for torsades de pointes

• Infusion site necrosis: Avoid perivascular/intra-arterial injection

• DRESS and SJS/TEN: Discontinue at first sign of rash

• Respiratory insufficiency: 25% of patients had abnormal respiration

• Neonatal exposure via breast milk or pregnancy can cause sedation or withdrawal