The Use of Primidone in Neonates with Theophylline-Resistant Apnea

Objective. —To determine whether primidone reduced the occurrence of apnea of prematurity in neonates with apnea resistant to theophylline. Design. —Retrospective review. Setting. —Neonatal intensive care unit. Participants. —Sixteen premature infants (mean age, 27.8 weeks) in whom apnea and bradycardia recurred despite therapeutic levels of theophylline. Six of the patients were receiving assisted ventilation. Intervention. —Administration of primidone (10 to 15 mg/kg per day) orally or by nasogastric tube at a mean age of 35 days. Results. —Apnea and bradycardia decreased significantly 24 to 72 hours after initiation of primidone treatment (by 68% and 69%, respectively) compared with pretreatment events. We obtained similar results after a separate analysis of the 10 patients who had been weaned from assisted ventilation before treatment with primidone. No toxic reactions were observed. Conclusions. —Primidone represents a possible adjuvant therapy in theophylline-resistant apnea of prematurity. Caution is advised, because of primidone's complex pharmacologic characteristics, until there are further controlled prospective studies.