title: A child exposed to primidone not prescribed for her.
abstract: A 7.5-year-old girl who was treated with phenobarbital (PHB) for epilepsy was admitted with decreased levels of consciousness. She had been known to have high PHB levels of unknown cause, without symptoms. Her PHB levels were very high, as expected, but primidone levels were also detected although she and her parents denied history of primidone administration. We wished to rule out intentional unprescribed use of primidone. Our retrospective review showed 3 other children with high PHB concentrations where primidone was also detected when PHB levels were over 130 μmol/L. Complementary studies confirmed that high-dose PHB can convert to its prodrug primidone, which has not been reported previously.
authors.affiliation: Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Reo
authors.initials: R
authors.lastname: Tanoshima
authors.forename: Geert W
authors.initials: GW
authors.lastname: 't Jong
authors.forename: Anthony
authors.initials: A
authors.lastname: Merlocco
authors.forename: Jeremy
authors.initials: J
authors.lastname: Simpson
authors.forename: Jeremy N
authors.initials: JN
authors.lastname: Friedman
authors.forename: David
authors.initials: D
authors.lastname: Colantonio
authors.forename: Gideon
authors.initials: G
authors.lastname: Koren
mesh_terms: D000818:Animals; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use*; D002648:Child; D004827:Epilepsy / Q000188:drug therapy; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000175:diagnosis; D006801:Humans; D010634:Phenobarbital / Q000009:adverse effects* / Q000627:therapeutic use; D011324:Primidone / Q000009:adverse effects* / Q000627:therapeutic use; D000091402:Prohibitins; D051381:Rats; D017207:Rats, Sprague-Dawley; D012189:Retrospective Studies
chemical_list: D000927:Anticonvulsants; C000717328:PHB protein, human; C000717332:Phb protein, rat; D000091402:Prohibitins; D011324:Primidone; D010634:Phenobarbital