Phenobarbital alternatives: What can I take instead of phenobarbital?

Compare phenobarbital alternatives | Dilantin | Lamictal | Neurontin | Tegretol | Topamax | Natural alternatives | How to switch meds

Phenobarbital is an FDA-approved prescription medication used to treat seizure disorders. It’s classified as an anticonvulsant because it is used for seizures. It is also known as a barbiturate medication. Barbiturates are antiepileptic drugs that cause central nervous system (CNS) depression, also known as sedative-hypnotics. They work by slowing down brain activity, which makes you feel drowsy and relaxed. They are often used to stop or prevent seizures in people with epilepsy. 

What can I take in place of phenobarbital?

Various anti-seizure medications are available to treat seizure disorders that do not improve with phenobarbital or when phenobarbital cannot be tolerated due to adverse effects or other issues. Another option may be more suitable—instead of, or in combination with, phenobarbital—for certain individuals due to their different uses, side effect profiles, or other unique factors that affect seizure control.

The table below compares phenobarbital, in bold, with some common alternatives used for epilepsy.

*Note that dosage varies based upon individual factors. Medications may be prescribed alone or with other medications, depending on each medication and its guidelines for use. The dosage in the chart is a general maintenance dose. Many medications will be started at a lower dose and slowly increased to the maintenance dose. There are various formulations available for some of these medications (such as immediate-release and extended-release), and dosages will vary. Consult a healthcare provider for dosing information. 

Other alternatives to phenobarbital

Brand names are listed first, with the active ingredient in parentheses. Drugs given by injection, such as Ativan* (lorazepam; given by intravenous route for status epilepticus), are not listed here.

• Banzel (rufinamide)
• Briviact (brivaracetam)
• Carbatrol (carbamazepine extended-release)
• Depakote ER (divalproex sodium extended-release)
• Elepsia XR (levetiracetam extended-release)
• Epitol (carbamazepine)
• Eprontia (topiramate)
• Equetro (carbamazepine)
• Felbatol (felbamate)
• Fycompa (perampanel)
• Gabitril (tiagabine)
• Keppra XR (levetiracetam extended-release)
• Klonopin (clonazepam)*
• Lamictal XR (lamotrigine extended-release)
• Lyrica CR (pregabalin extended-release)
• Mysoline (primidone)
• Onfi, Sympazan (clobazam)*
• Oxtellar XR (oxcarbazepine extended-release)
• Qudexy XR (topiramate extended-release)
• Sabril, Vigradone (vigabatrin)
• Spritam (levetiracetam disperse tablet)
• Tegretol XR (carbamazepine extended-release)
• Trokendi XR (topiramate extended-release)
• Valium (diazepam)*
• Valproic acid
• Xcopri (cenobamate)
• Zarontin (ethosuximide)
• Zonegran (zonisamide)

*These medications are benzodiazepines. According to the recently updated guidelines American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults, benzodiazepines are not recommended for use in adults ages 65 years and older. This is due to the risk of dependence and cognitive impairment, delirium, falls, fractures, and vehicle crashes in this population. However, some healthcare providers may choose to prescribe a benzodiazepine to an older adult if they feel the benefits outweigh the risks.

Top 5 phenobarbital alternatives

The following are some of the most common alternatives to phenobarbital. General information will be provided about each medication. It is important to note that each medication has its list of drug interactions, which is too extensive to list here, so while choosing a medication, you should tell your healthcare provider about all the medications you take, including prescription and over-the-counter drugs, vitamins, and supplements. For more information and professional medical advice, consult a healthcare provider. 

1. Dilantin (phenytoin)

Dilantin contains the active ingredient phenytoin. Dilantin is an anticonvulsant. Its mechanism of action (the way it works) reduces abnormal electrical activity in the brain. It is available as extended-release capsules, chewable tablets, oral suspension, and injections. Dilantin can be used to prevent seizure activity from various types of seizures and treat status epilepticus. 

Common side effects include nausea, vomiting, constipation, rash, involuntary eye movements, impaired coordination, speech problems, dizziness, confusion, numbness and tingling, blurry vision, drowsiness, headache, taste changes, and gingival (gum) overgrowth. 

Serious side effects may occur with Dilantin, including a severe skin reaction (symptoms may include fever, sore throat, burning eyes, skin pain, red or purple rash, blistering/peeling skin) or a serious drug reaction that affects many parts of the body (symptoms may include rash, fever, swelling, muscle ache, weakness, bruising, or yellowing of the skin or whites of the eyes). These reactions require emergency medical help. Other serious side effects may include but are not limited to, mood or behavior changes, anxiety, panic attack, aggression, depression, and suicidal thoughts or behavior. 

2. Lamictal (lamotrigine)

Lamictal is an anticonvulsant medication with the active ingredient lamotrigine. It can be used alone or as an add-on with other medications to treat patients with epilepsy who have certain types of seizures. It is also used to treat bipolar I disorder. Lamictal is available in immediate-release tablets, extended-release tablets, chewable tablets, and orally disintegrating tablets.

Common side effects include headache, flu-like symptoms, fever, nausea, vomiting, diarrhea, indigestion, dizziness, sleepiness, impaired coordination, vision problems, stuffy nose, sore throat, and rash. 

Lamictal has a black box warning, the strongest warning required by the U.S. Food and Drug Administration (FDA). This warning states that Lamictal can cause severe rashes that require hospitalization and discontinuation of the medication. These life-threatening rashes are known as Stevens-Johnson syndrome and toxic epidermal necrolysis. Most life-threatening rashes occur in the first two months of treatment. If you experience rash, hives, blistering or peeling skin, fever, sore throat, burning eyes, skin pain, or sores around the mouth or eyes, get emergency medical help. 

Other serious side effects of Lamictal include but are not limited to swelling, liver (hepatic) problems, depression, and suicidal thoughts and behaviors. 

3. Neurontin (gabapentin)

Neurontin contains the active ingredient gabapentin. Gabapentin is an anticonvulsant and is available as an oral tablet, oral capsule, and oral solution. The way it works is not entirely understood. It is thought to mirror the effects of a chemical messenger called gamma-aminobutyric acid (GABA), which calms excited nerve cells in the brain, controlling seizures (and also helping nerve pain). 

Gabapentin is combined with other medication(s) to treat partial-onset seizures in adults and children three years and older with epilepsy. Gabapentin can also be used to treat nerve pain from shingles in adults.

Common side effects in adults and adolescents older than 12 include sleepiness, dizziness, impaired coordination, fatigue, and uncontrolled eye movements. Common side effects in patients three years to 12 years old include virus, fever, nausea, vomiting, sleepiness, and hostility. 

Serious side effects may include but are not limited to depression, suicidal thoughts and behaviors, life-threatening skin reactions, and swelling. Neurontin can also cause slowed breathing, especially when combined with CNS depressant medications such as opioid painkillers, sleeping medications, or anxiety medicines. 

4. Tegretol (carbamazepine)

Tegretol contains the active ingredient carbamazepine. It is available as immediate-release tablets, chewable tablets, extended-release tablets, and oral suspension. As an anticonvulsant, it reduces abnormal electrical activity in the brain. 

Tegretol can treat partial seizures, grand mal (generalized tonic-clonic), mixed seizures, or other partial or generalized seizures. It can also treat pain associated with trigeminal neuralgia, a chronic pain condition involving the trigeminal nerve in the face. 

Common side effects include dizziness, drowsiness, nausea, vomiting, constipation, impaired coordination, dry mouth, itching/rash, blurry vision, speech problems, high blood pressure, tremor, muscle twitching, low sodium levels in the blood, and sun sensitivity. 

Tegretol has a black box warning. The warning states that serious, life-threatening skin reactions may occur, which can cause death, including Stevens-Johnson syndrome and toxic epidermal necrolysis. Asian patients are at higher risk due to a variant form of a gene called the HLA-B*1502 allele. Certain patients will need to be screened for this allele before taking Tegretol, and those who test positive should not take Tegretol unless the benefits strongly outweigh the risks. The black box warning also notes that there is a risk of aplastic anemia (a serious condition where the bone marrow does not make enough new blood cells) and agranulocytosis (a condition where the body has too few granulocytes, a type of white blood cells, making it harder to fight infection). Patients will be closely monitored during treatment. 

Other serious side effects may include but are not limited to low platelets, swelling, irregular heartbeat, inflammation of the pancreas, and suicidal thoughts and behaviors. Infertility in men may also occur. 

5. Topamax (topiramate)

Topamax contains the active ingredient topiramate. It is an anticonvulsant and works by decreasing abnormal excitement in the brain. It can be used alone (monotherapy) or with other medication to treat partial seizures and primary generalized tonic-clonic seizures. In combination with other medicines, it can be used to treat seizures associated with Lennox Gastaut syndrome. Topamax can also be used to prevent migraine.

Common side effects include numbness and tingling, appetite and weight loss, speech problems, fatigue, dizziness, sleepiness, nervousness, abnormal vision, fever, and slowing down mental and physical activities. 

Serious side effects include but are not limited to, life-threatening skin reactions, kidney stones, bone softening/weak bones, low potassium levels, glaucoma, other vision problems, and suicidal thoughts and behaviors. 

Natural alternatives to phenobarbital

There are no phenobarbital alternatives that can be purchased in the vitamin or supplement aisle. Studies show little evidence of the safety and efficacy of these natural products. If you do want to try a supplement, always consult your healthcare provider to ensure it is safe for you to use, and ask if you can use it in combination with (not as a replacement for) your prescription medication. While studies are ongoing, CBD or medical cannabis may help some patients with epilepsy, but consult a healthcare provider before using

Also, while they are not alternatives to prescription medication, some lifestyle changes you can try may help with seizure control when used as part of a treatment plan in combination with your prescribed medicine(s). Examples include:

• Getting enough quality sleep
• Avoiding drugs and alcohol
• Minimizing stress
• Exercising regularly (consult your physician before beginning any new exercise program)

You can also talk to your healthcare provider about other lifestyle changes you can try. 

How to switch to a phenobarbital alternative

The information provided above is a general overview of phenobarbital alternatives, and it is not personal medical advice. If you feel like phenobarbital is not the most appropriate choice, talk to your healthcare provider. 

There are many individual factors to consider when choosing (or switching) seizure medication, including the type of seizures you have, other medical conditions, family history, potential side effects, other medications you take, and more. 

Because each anticonvulsant medication has a long list of possible side effects, some of which can be serious or life-threatening, you should review potential side effects with your healthcare provider, ensuring you know when to seek emergency medical attention. 

Phenobarbital is a controlled substance and can be habit-forming. This medication should not be stopped abruptly because it could cause serious withdrawal symptoms, including delirium, seizures, and possibly death. The prescribing information recommends that when phenobarbital is discontinued, it should be done cautiously and gradually. It is important to communicate with your healthcare provider and, if switching medication, follow the directions for use closely. 

You can consult your insurance provider or pharmacist for more information about drug coverage and costs. You can always use a free SingleCare card or coupon to save up to 80% on the cost of your medications and refills.