Pentobarbital
Class: Barbiturates
VA Class: CN301
CAS Number: 76-74-4
Brands: Nembutal
Warning
Special Alerts:
A standardized concentration for this drug has been established through Standardize 4 Safety (S4S), a national patient safety initiative to reduce medication errors, especially during transitions of care. The drug is included in a standard concentration list which may apply to an IV or oral compounded liquid formulation. For additional information, see the ASHP website [Web].
Introduction
Barbiturate; anxiolytic, sedative, hypnotic, and anticonvulsant.
Uses for Pentobarbital
Insomnia
Short-term treatment of insomnia (i.e., ≤2 weeks duration); decreased effectiveness for sleep induction and maintenance after 2 weeks.
Has been used for routine sedation. However, barbiturates used infrequently for this indication since there are few clinical situations in which oral barbiturates provide a safety or efficacy advantage over nonbarbiturate sedatives/hypnotics.
Surgery and Preanesthesia
Preoperatively, to produce sedation and relieve anxiety.
Provide basal hypnosis for general, spinal, or regional anesthesia, or to facilitate intubation procedures.
Seizure Disorders
Alternate therapy to control status epilepticus or acute seizure episodes resulting from meningitis, poisons, eclampsia, alcohol withdrawal, tetanus, or chorea.
IV diazepam generally considered drug of choice for termination of status epilepticus.
Drug Withdrawal
Withdrawal of barbiturate or nonbarbiturate hypnotics in physically dependent patients.
Agitated Behavior
Has been used to control acute episodes of agitated behavior in psychoses†; however, little value in long-term management of psychoses.
Coma Induction
Has been used in high doses to induce coma in the management of cerebral ischemia† and increased intracranial pressure† associated with head trauma, stroke, Reye’s syndrome, cardiac arrest, asphyxiation, or drowning.
Has been used to ameliorate or prevent sequelae associated with cerebral ischemia during neurosurgical procedures† that require long periods of cerebral hypoxia.
Pentobarbital Dosage and Administration
General
Adjust dosage carefully and slowly according to individual requirements and response.
Following chronic administration, withdraw pentobarbital slowly to avoid the possibility of precipitating withdrawal symptoms if the patient is physically dependent on the drug.
To prevent rebound in rapid eye movement (REM) sleep, withdrawal of a single therapeutic dose over 5 or 6 days (e.g., reducing dosage from 3 to 2 doses daily for 1 week) has been recommended when barbiturates are discontinued following prolonged use.
Insomnia
Do not administer for periods >2 weeks.
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