Monitoring of phenobarbitone in epileptic children.

Seventy-five children with different nutritional status, who were receiving phenobarbitone for treatment of various seizure disorders, were monitored for their plasma steady state level, therapeutic efficacy and toxicity. A wide inter individual variation in the steady state level was observed. About 10 percent of them had subtherapeutic level, while nearly 30 percent of them had potentially toxic levels, the remaining were within therapeutic range of 10-25 micrograms/ml. Poor compliance was found to be an important contributing factor for the variations in the level. Steady state levels were significantly higher in children with grade II protein energy malnutrition (PEM) than normally nourished children. A good correlation existed between plasma drug level and therapeutic response in nearly 60 percent of the children. Clinical toxicity was observed in nearly two thirds of the children, sedation and behavioral problems being the most common. The importance of monitoring the drug level is discussed for the proper management of epileptic children.