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Test ID MEPHS Mephobarbital and Phenobarbital, Serum

Reporting Name

Mephobarbital and Phenobarbital, S

Useful For

Monitoring of mephobarbital and phenobarbital therapy

Profile Information

Test ID Reporting Name Available Separately Always Performed
MBARS Mephobarbital, S No Yes
PHBRS Phenobarbital, S No Yes

Specimen Type

Serum Red


Specimen Required


Collection Container/Tube: Red top (Serum gel/SST are not acceptable)

Submission Container/Tube: Plastic vial

Specimen Volume: 1.2 mL

Collection Instructions:

1. Draw blood immediately before next scheduled dose.

2. Centrifuge and aliquot serum in plastic vial within 2 hours of collection.


Specimen Minimum Volume

0.7 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Red Refrigerated (preferred) 14 days
  Ambient  14 days
  Frozen  14 days

Reference Values

MEPHOBARBITAL

Therapeutic range: 1.0-7.0 mcg/mL

Toxic concentration: ≥15.0 mcg/mL

 

PHENOBARBITAL

Therapeutic range

Children: 15.0-30.0 mcg/mL

Adults: 20.0-40.0 mcg/mL

Toxic concentration: ≥60.0 mcg/mL

Day(s) and Time(s) Performed

Friday; Varies

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information

80345

G0480 (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
MEPHS Mephobarbital and Phenobarbital, S In Process

 

Result ID Test Result Name Result LOINC Value
89706 Mephobarbital, S 3750-7
84582 Phenobarbital, S 3948-7

Clinical Information

Mephobarbital is an orally administered, methylated barbiturate used for the treatment of epilepsy.(1,2) It is demethylated by hepatic microsomal enzymes to generate its major metabolite, phenobarbital. During long-term use, most of the mephobarbital activity can be attributed to the accumulation of phenobarbital. Consequently, the pharmacological properties, toxicity, and clinical uses of mephobarbital are the same as phenobarbital.(1,2) The use of mephobarbital is uncommon as it offers no significant advantage over phenobarbital alone.(1,2)

Interpretation

Mephobarbital concentrations above 15 mcg/mL have been associated with toxicity.

 

Phenobarbital concentrations between 35 and 80 mcg/mL have been associated with slowness, ataxia, and nystagmus, while concentrations above 100 mcg/mL have been associated with coma without reflexes.

Clinical Reference

1. Baselt RC: Disposition of Toxic Drugs and Chemicals in Man. 10th ed. Biomedical Publications; 2014:2211

2. Milone MC, Shaw LM: Therapeutic drugs and their management. In: Rifai N, Horvath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:800-831

3. Langman LJ, Bechtel LK, Meier BM, Holstege C: Clinical toxicology. In: Rifai N, Horvath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier: 2018:832-887

4. Mihic SJ, Mayfield J, Harris RA: Hypnotics and sedatives. In: Brunton LL, Hilal-Dandan R, Knollmann BC, eds. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 13th ed. McGraw-Hill Education; 2017

Analytic Time

1 day

Method Name

Gas Chromatography-Mass Spectrometry (GC-MS)

Forms

If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.