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Pentobarbital

    Brands

    DEA Class;  Rx

    Common Brand Names; Nembutal

    • Sedative/Hypnotics; 
    • Barbiturates

    Short-acting oral and parenteral barbiturate; for preoperative anxiety, sedation, refractory seizures, or to induce coma for increased intracranial pressure; rarely used for insomnia due to rapid development of tolerance; close monitoring for emerging or worsening suicidal thoughts/behavior or depression is recommended.

    Indicated for procedural sedation or for use as a preanesthetic medication.

    For the treatment of acute convulsive episodes, including status epilepticus.
    For the short-term treatment of insomnia.
    For the reduction of increased intracranial pressure (ICP) in patients with traumatic brain injury (i.e., head trauma).
    For sedation maintenance and to alleviate agitation and anxiety in patients refractory to standard therapy who are mechanically-ventilated.

    Hypersensitivity to barbiturates or excipients

    History of latent porphyria

    Angioedema (rare)

    Bradycardia

    Hypotension

    Agitation

    Ataxia

    CNS depression

    Confusion

    Dizziness

    Fever

    Headache

    Hyperkinesia

    Nightmares

    Nervousness

    Somnolence (frequent)

    Syncope

    Rash

    Stevens-Johnson syndrome

    Constipation

    Nausea

    Vomiting

    Agranulocytosis (rare)

    Megaloblastic anemia with prolonged use (rare)

    Injury of liver with prolonged use (rare)

    SLE

    Apnea

    Too rapid administration may cause respiratory depression, laryngospasm, apnea, or vasodilation with fall in blood pressure

    Exercise caution when administered to patients with acute or chronic pain; could result in paradoxical excitement or important symptoms could be masked

    The use of barbiturates as sedatives in the postoperative surgical period and as adjuncts to cancer chemotherapy is well established

    Administer barbiturates with caution in patients with hepatic damage and at reduced doses initially; barbiturates should not be administered to patients showing the premonitory signs of hepatic coma

    Concomitant use of alcohol or other CNS depressants may produce additive CNS depressant effects

    Elderly or debilitated patients may react to barbiturates with marked depression, excitement, and confusion; in some patients, barbiturates repeatedly produce excitement rather than depression

    Parenteral solutions of barbiturates are highly alkaline; extreme care should be taken to avoid perivascular extravasation or intra-arterial injection; extravascular injection may cause local tissue damage with subsequent necrosis; consequences of intra-arterial injection may vary from transient pain to gangrene of the limb; any complaint of pain in the limb warrants stopping the injection

    Barbiturates can cause fetal damage when administered to a pregnant woman; retrospective, case-controlled studies have suggested a connection between maternal consumption of barbiturates and a higher-than-expected incidence of fetal abnormalities

    Exercise caution when a barbiturate is administered to a nursing woman; small amounts of barbiturates are excreted in the milk

    Adults

    Specific maximum dosage information not available; individualize dosage based on clinical parameters and serum pentobarbital concentrations.

    Geriatric

    Specific maximum dosage information not available; individualize dosage based on clinical parameters and serum pentobarbital concentrations.

    Adolescents

    Specific maximum dosage information not available; individualize dosage based on clinical parameters and serum pentobarbital concentrations. For procedural sedation, doses above 6 mg/kg/dose IM/IV/PO (Max: 100 mg/dose) are not usually necessary.

    Children

    Specific maximum dosage information not available; individualize dosage based on clinical parameters and serum pentobarbital concentrations. For procedural sedation, doses above 6 mg/kg/dose IM/IV/PO (Max: 100 mg/dose) are not usually necessary.

    Infants

    Specific maximum dosage information not available; individualize dosage based on clinical parameters and serum pentobarbital concentrations. For procedural sedation, doses above 6 mg/kg/dose IM or IV and 8 mg/kg/dose PO (Max: 100 mg/dose) are not usually necessary.

    Neonates

    Specific maximum dosage information not available; individualize dosage based on clinical parameters and serum pentobarbital concentrations. For procedural sedation, doses above 6 mg/kg/dose IV are not usually necessary.

    Pentobarbital sodium

    injectable solution: Schedule II

    • 50mg/mL