After investigators reported that phenobarbital was found in Ivaylo Kalushev's blood, a NOVA team checked what this drug is, in what cases it is used and what effects it can cause. There is currently no information on whether the substance was taken for medical reasons or for another purpose.
We sought out experts who are not affiliated with the investigation to obtain more information about phenobarbital.
Toxicologist Assoc. Prof. Margarita Gesheva notes that decades ago, phenobarbital intoxications were significantly more common.
"While 30 years ago, phenobarbital intoxication was an everyday occurrence, now we have no more than five cases of poisoning or self-poisoning“, she points out.
According to her, the drug was used primarily to treat epilepsy in the past. However, with the introduction of more modern antiepileptic drugs, phenobarbital has gradually been displaced from therapeutic practice.
"It is a drug that was used primarily against epilepsy. Much more modern medications from other groups have entered neurology therapy, completely replacing it as an antiepileptic agent,“ explains Gesheva.
Phenobarbital belongs to the group of barbiturates and has a depressing effect on the central nervous system.
Prof. Georgi Momekov specifies that when taking higher amounts, the effect develops gradually and can be severe: "When taking a larger dose, the effect goes through sedation – that is, calming, sleep, general anesthesia or narcosis, coma and death“.
Experts emphasize that overdose leads to suppression of brain activity and slowing down of the body's reactions.
According to Prof. Momekov, low doses of phenobarbital can also be contained in some combination medications. "There are low doses of phenobarbital in some combination products - analgesics, sedatives, but in general it is not widely used. There the doses are so low that they do not cause concern", he explains.
Assoc. Prof. Gesheva adds that the tablet form of pure phenobarbital is practically absent in our country. "It is available in a combined form, such as belergamine, and in ampoule form", she says.
A check shows that the medication cannot be purchased freely from a pharmacy. "It cannot be taken easily. It is a controlled medicinal product. It is dispensed by green prescription. You cannot just come, order it and we will dispense it", explains a pharmacist.
Prof. Momekov assumes that if the substance is procured outside the regulated order, this could happen from another country. "Probably, in order to have it, it must have been purchased in some way – perhaps from a neighboring country“, he commented.
Experts are adamant that phenobarbital has a high potential for developing addiction. With prolonged use, tolerance can develop, which requires increasing the dose to achieve the same effect.
Abruptly stopping the intake, especially after prolonged use, can lead to severe withdrawal symptoms, including hallucinations.
At this point in the investigation, it is unclear under what circumstances the presence of phenobarbital in Ivaylo Kalushev's blood was detected. Experts emphasize that without specific data on the dose, method of administration and medical history, no conclusions can be drawn about a causal relationship.