Phenobarbital-Induced Hepatic Dysfunction

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Abstract
Phenobarbital has infrequently been reported to cause hepatitis. The previously reported cases of barbiturate-induced jaundice are reviewed and data from two previously unreported cases are presented. A discussion of mechanisms of iatrogenic hepatotoxicity is presented with emphasis on idiosyncratic mechanisms. Hepatitis secondary to phenobarbital administration appears to be due to a hypersensitivity reaction. This mechanism seems most likely because of the commonly seen clinical picture of rash, fever and eosinophilia. Speculation is made that phenobarbital hepatitis is possibly more common than the small number of reported cases would indicate. Criteria for the assessment and treatment of this iatrogenic disease are presented.

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