WARNINGOVERDOSE, COMBINATIONS, & WITHDRAWAL CAN BE FATAL
High doses alone or ordinary doses in combination with other depressants can fatally stop breathing. After prolonged dependency, stopping suddenly can cause seizures, delirium, or death.
Phenobarbital
Phenobarbital is a long-acting barbiturate that functions as a nonselective central nervous system depressant1, producing potent anxiolytic, hypnotic, muscle relaxant, and amnesic effects. It is used medically as an anticonvulsant for the management of most seizure disorders except absence seizures2. Compared to other barbiturates, it is distinguished by its extremely slow elimination rate and prolonged duration of actioncitation needed. It is classified as habit-forming.
Dosage & Duration
Dosage
Doses are population estimates that vary widely between individuals.
Duration
Subjective Effects
Legacy content. A statistically backed ontology from Mindstate Design Labs is coming soon.
The experience is dominated by nonselective central nervous system depression, producing heavy sedation and sleepiness that build steadily and persist for an unusually long time owing to phenobarbital's status as the longest-acting barbiturate. The character of the intoxication resembles alcohol, with drowsiness, cognitive dulling, and impaired coordination rather than any notable sensory alteration. At high doses the depressant effects deepen dangerously, progressing toward respiratory depression, unconsciousness, and coma.
Physical
Pronounced sedation and muscle relaxation define the body load, accompanied by dizziness and unsteady coordination. In overdose, breathing slows, blood pressure and body temperature fall, and the pupils constrict, with severe poisoning capable of ending in circulatory collapse, respiratory arrest, and death.
Cognitive
The headspace is heavy and clouded, marked by slowed thinking, reduced inhibitions, and impaired memory formation; recall of the period under the drug's influence can be patchy or absent at higher doses.
Suppressions
Pharmacology
Pharmacodynamics
Phenobarbital acts primarily as a positive allosteric modulator at GABA-A receptors, binding at the barbiturate site to extend the duration of chloride ion channel opening and thereby enhancing inhibitory neurotransmission.citation needed It also directly blocks glutamatergic AMPA and kainate receptors, which is believed to contribute to its anticonvulsant properties. Additional targets include NMDA receptors, neuronal nicotinic acetylcholine receptors (α4 and α7 subunits), and possibly voltage-gated calcium channels.
Pharmacokinetics
Phenobarbital has an oral bioavailability of approximately 90%,citation needed with peak plasma concentrations reached 8 to 12 hours after oral administration. It is metabolized hepatically, primarily through hydroxylation and glucuronidation, with CYP2C19 as a major metabolic enzyme. Phenobarbital is a potent inducer of multiple cytochrome P450 isozymes; CYP2B6 is specifically induced via the CAR/RXR nuclear receptor heterodimer. It exhibits low protein binding (20 to 45%) and is excreted primarily by the kidneys, with an elimination half-life ranging from approximately 53 to 118 hours.
Dangerous
Highest riskThese combinations are considered extremely harmful and should always be avoided. Reactions to these drugs taken in combination are highly unpredictable and have a potential to cause death.
Caution
Use cautionThese combinations are not usually physically harmful, but may produce undesirable effects, such as physical discomfort or overstimulation. Extreme use may cause physical health issues. Synergistic effects may be unpredictable. Care should be taken when choosing to use this combination.
Tolerance
Tolerance timelines are rules of thumb, not exact schedules, and vary widely between individuals and use patterns.
Barbiturates
Harm Potential
Addiction & Dependence
Psychological
HighHigh psychological addiction potential with compulsive redosing commonly reported.citation needed Long-acting barbiturates have moderate to high abuse potential.
Physical
Extremely HighExtremely physically addictive with life-threatening withdrawal potential.citation needed Abrupt discontinuation in dependent individuals may cause seizures, psychosis, and death. Medical supervision is essential for discontinuation.
Toxicity
Respiratory depression is a primary toxicity concern at high doses and in overdose, potentially progressing to Cheyne-Stokes respiration, apnea, and respiratory arrest.citation needed
CNS depression ranging from sedation to coma occurs in a dose-dependent manner; severe overdose can produce EEG patterns mimicking brain death, though this is usually reversible with treatment.citation needed
Phenobarbital is a potent cytochrome P450 enzyme inducer; severe liver failure is a contraindication for use, suggesting potential hepatic burden in those with compromised liver function.citation needed
Acute renal failure may occur in massive overdose as a consequence of shock and circulatory collapse rather than direct nephrotoxicity.
Overdose can cause bradycardia, hypotension, lowered body temperature, and circulatory collapse; typical shock syndrome may develop in severe cases.citation needed
Studies have linked the use of barbiturates, particularly phenobarbital, with the development of cancer.1
Psychosis Risk
Psychosis is not typical during intoxication but may occur during withdrawal in physically dependent individuals.citation needed Withdrawal-induced psychosis can be severe and life-threatening.
Seizure Risk
Phenobarbital is an anticonvulsant that suppresses seizures during use. However, abrupt discontinuation in dependent individuals may paradoxically trigger severe, potentially life-threatening seizures.citation needed Drugs which lower the seizure threshold should be avoided during withdrawal.
History & Culture
Discovery and Early Development
The barbiturate class emerged in 1902 when German chemists Emil Fischer and Joseph von Mering synthesized barbital, the first compound of its kind, subsequently marketed as Veronal by Bayer.citation needed By 1904, Fischer had synthesized several related compounds including phenobarbital. The
Legality
International
Phenobarbital is not listed in the schedules to the 1961 Single Convention on Narcotic Drugs.
Phenobarbital is listed in Schedule IV of the Convention on Psychotropic Substances 1971. Parties apply the convention’s Schedule IV controls to international trade and domestic handling.
Phenobarbital is not listed in the Tables of the 1988 Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances.
By Country
References
Source Pages
Citations
- Phenobarbital tablet — DailyMed (setid 069b92ce). (n.d.). https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=069b92ce-0061-4724-8c25-08d8596770a212
- Revisiting phenobarbital for epilepsy: Large gaps in knowledge still exist, but we may be underestimating its clinical value. (n.d.). https://pmc.ncbi.nlm.nih.gov/articles/PMC529354/1
- Antiepileptic Overdose — PMC 6996662. (n.d.). https://pmc.ncbi.nlm.nih.gov/articles/PMC6996662/1
- Francisco López-Muñoz, Ronaldo Ucha-Udabe, & Cecilio Alamo. (December 2005). The history of barbiturates a century after their clinical introduction. Neuropsychiatric Disease and Treatment, 1(4), 329–343. https://pubmed.ncbi.nlm.nih.gov/18568113/1
- Yasiry Z, & Shorvon SD. (December 2012). How phenobarbital revolutionized epilepsy therapy: The story of phenobarbital therapy in epilepsy in the last 100 years. Epilepsia, 53(Suppl 8). https://doi.org/10.1111/epi.120261
- Heaven's Gate | UFOs, Mass Suicide, New Religious Movement, Cult & Marshall Applewhite. Encyclopaedia Britannica (n.d.). https://www.britannica.com/topic/Heavens-Gate-religious-group1
- Argentina.gob.ar / ANMAT, Disposición 6019/1996 — Especialidades medicinales: venta bajo receta–fenobarbital. argentina.gob.ar (n.d.). https://www.argentina.gob.ar/normativa/nacional/disposici%C3%B3n-6019-1996-410791
- Argentina.gob.ar, Disposición 6019/1996 — normas que complementan o modifican. argentina.gob.ar (n.d.). https://www.argentina.gob.ar/normativa/nacional/disposici%C3%B3n-6019-1996-41079/normas-modifican1
- Argentina.gob.ar, Ley 19.303 — texto actualizado. argentina.gob.ar (n.d.). https://www.argentina.gob.ar/normativa/nacional/ley-19303-20966/actualizacion1
- Therapeutic Goods (Poisons Standard—June 2026) Instrument 2026. legislation.gov.au (n.d.). https://www.legislation.gov.au/F2026L00633/asmade/2026-05-28/text/original/pdf1
Further Reading
Article Status
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Josie Kins · Updated the article · also 1,4-Butanediol, 1B-LSD, 1cP-AL-LAD and 573 more
Josie Kins · Updated the article · also 1,4-Butanediol, 1B-LSD, 1cP-AL-LAD and 573 more
Josie Kins · Updated the article · also 1,4-Butanediol, 1B-LSD, 1cP-AL-LAD and 573 more
Josie Kins · Updated the article · also 1,4-Butanediol, 1B-LSD, 1cP-AL-LAD and 573 more
Josie Kins · Updated the article · also 1,4-Butanediol, 1B-LSD, 1cP-AL-LAD and 573 more
Josie Kins · Updated the article · also 1,4-Butanediol, 1B-LSD, 1cP-AL-LAD and 573 more
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