Why is Phenobarbital considered a highly cost-effective treatment for early and established Status Epilepticus (SE)?

Phenobarbital has fallen out of favor in many European countries due to reports of hypotension, arrhythmias, and hypopnea, despite its strong antiseizure effect with remarkably little sedation. However, data from randomized and large non-randomized studies suggest it is well tolerated even in very high doses.

Despite a decline in its popularity, at least in Europe and North America, phenobarbital should be considered a highly cost-effective treatment for early and established SE, not only in resource-limited settings. It also offers rapid and long-lasting action, a broad spectrum of efficacy (except for absence status), is easy to use, and is stable in solution.