Emer 30 mg Tablet

Barbiturate antiepileptic for:

• Generalised tonic-clonic and focal seizures (widely used in resource-limited settings)
• Neonatal seizures (first-line, hospital)
• Status epilepticus (IV, hospital, when other drugs fail)

Adults (epilepsy): 60–180 mg once daily at night (usually 1–3 mg/kg/day).

Children: 3–8 mg/kg daily in 1–2 doses (specialist; monitor behaviour).

Neonatal seizures: loading 20 mg/kg IV, then 2.5–5 mg/kg daily (hospital).

Status epilepticus: 10–20 mg/kg IV slowly (hospital, with breathing support).

• Long half-life — takes 2–3 weeks to reach steady levels.
• Never stop suddenly (risk of severe seizures and withdrawal); reduce very gradually.

• Acute intermittent porphyria
• Severe respiratory depression
• Severe liver or kidney impairment
• Allergy to barbiturates

Common: drowsiness, sluggishness, reduced concentration and memory, unsteadiness; hyperactivity and irritability in children; depression in adults.

Long-term: dependence, folate deficiency (anaemia), osteomalacia (vitamin D deficiency), Dupuytren's contracture, reduced libido.

Serious: breathing depression (high doses, IV, with other sedatives), severe skin reactions (SJS/TEN, DRESS), liver injury, suicidal thoughts.

• Avoid alcohol and other sedatives; do not drive if drowsy.
• Long-term: consider vitamin D, calcium and folic acid; check bone health.
• Elderly: confusion and falls risk.
• Report rash, fever or mood changes promptly.

Associated with birth defects and neonatal withdrawal/bleeding (give vitamin K); continue only if the benefit outweighs the risk, with specialist planning and folic acid. Passes into milk — watch the baby for drowsiness and poor feeding.

Strong liver-enzyme inducer — reduces effect of many drugs:

• Oral contraceptives (use other contraception), warfarin, steroids, antiretrovirals, other antiepileptics (lamotrigine, carbamazepine, valproate changes), calcium-channel blockers, theophylline, doxycycline, ciclosporin
• Valproate raises phenobarbital levels (sedation)
• Alcohol, opioids, benzodiazepines (dangerous sedation)

Deep sleep, slurred speech, unsteadiness, slow breathing, low blood pressure, hypothermia, coma — emergency care.

Store below 30°C, protected from light.