amobarbital (Rx)

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Brand and Other Names:Amytal Sodium

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

powder for injection: Schedule II

  • 500mg
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Sedative

30-50 mg IV q8-12hr

Hypnotic

Used as a hypnotic, for short-term treatment of insomnia; effectiveness for sleep induction and sleep maintenance is lost after 2 weeks

65-200 mg IV qHS

Dosage Forms & Strengths

powder for injection: Schedule II

  • 500mg
more...

Sedative

<6 years: Safety and effectiveness not established

6-12 years: 65 mg-500 mg IV/IM

>12 years: 30-50 mg IV q8-12hr

Hypnotic

Used as a hypnotic, for short-term treatment of insomnia; effectiveness for sleep induction and sleep maintenance is lost after 2 weeks

<6 years: Safety and effectiveness not established

6-12 years: 2-3 mg/kg; not to exceed 500 mg IV/IM 

>12 years: 65-200 mg IV qHS

Reduce dose in the elderly or debilitated because these patients may be more sensitive to barbiturates

Elderly and debilitated patients may react with marked excitement, depression, or confusion

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Interactions

Interaction Checker

and amobarbital

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    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            Somnolence

            <1%

            Nervous system: agitation, confusion, hyperkinesia, ataxia, CNS depression, nightmares, nervousness, psychiatric disturbance, hallucinations, insomnia, anxiety, dizziness, abnormality in thinking

            Cardiovascular system: Bradycardia, hypotension, syncope

            Respiratory system: apnea, hypoventilation, postoperative atelectasis

            Digestive system: Constipation, vomiting, nausea

            Other adverse effects: Headache, injection site reactions, hypersensitivity reactions, fever, liver damage, megaloblastic anemia following chronic phenobarbital use

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            Warnings

            Contradindications

            Hypersensitivity

            Patients with history of manifest or latent porphyria

            Significant impairment of liver function

            Respiratory disease in which dyspnea or obstruction is evident

            Cautions

            Habit forming; tolerance and psychological dependence may occur with continued use

            Caution in patients that are mentally depressed, have suicide ideation or history of drug abuse and hepatic damage

            Rapid administration may cause respiratory depression, apnea, laryngospasm, or vasodilatation with decrease in blood pressure

            Parenteral solutions of barbiturates are highly alkaline; care should be taken to avoid perivascular extravasation or intra-arterial injection

            Amobarbital may diminish systemic effects of exogenous and endogenous corticosteroids. Administer with caution to patients with borderline hypoadrenal function, regardless of whether it is of pituitary or of primary adrenal origin

            Possible impairment of mental and/or physical abilities required for the performance of potentially hazardous tasks, such as driving a car or operating machinery

            Concurrent use of barbiturates with other CNS depressants (eg, alcohol, narcotics, tranquilizers, antihistamines) may result in increased CNS-depressant effects

            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

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            Pregnancy & Lactation

            Pregnancy Category: D

            Lactation: small amounts of barbiturates are excreted in the milk; use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Depress the sensory cortex by interfering with transmission of impulses from thalamus. This results in decreased motor activity, altered cerebellar function, drowsiness, sedation, and hypnosis

            Onset of Action

            Within 5 minutes

            Metabolism

            Primarily hepatic via microsomal enzymes

            Elimination

            Half-Life: 15-40 hours in adults (mean 25 hours)

            Excretion: feces, urine

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            Administration

            IV Administration

            Slow IV injection is essential; observe patients carefully during administration

            Blood pressure, respiration, and cardiac function must be maintained, vital signs be recorded and equipment for resuscitation and artificial ventilation be available

            The rate of IV injection for adults should not exceed 50 mg/min to prevent sleep or sudden respiratory depression

            Final dosage is determined largely by the patient’s reaction to the slow administration of the drug

            IM Administration

            IM injection of the sodium salts of barbiturates should be made deeply into a large muscle

            Average IM dose ranges from 65 mg-500 mg; volume of 5 mL (irrespective of concentration) should not be exceeded at any one site because of possible tissue irritation

            Twenty percent solutions may be used so that a small volume can contain a large dose; monitor vital signs after IM injection of hypnotic dose

            Superficial IM or subcutaneous injections may be painful and may produce sterile abscesses or sloughs

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
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            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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