pentobarbital (Rx)

Brand and Other Names:Nembutal
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

injectable solution: Schedule II

  • 50mg/mL
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Hypnotic

Initial: 100 mg IV OR 150-200 mg IM

May give small increments of drug after at least 1 minute to reach full effect

Not to exceed 500 mg

Barbiturate Coma

Load: 10-15 mg/kg IV over 30 min; follow by 5 mg/kg IV q1hr for 3 doses 

Maintenance: 1 mg/kg/hr IV; may increase to 2-4 mg/kg/hr

Renal Failure

Use lower dose

Hepatic Failure

Use lower dose

Other Indications & Uses

Acute convulsive episodes

Dosage Forms & Strengths

injectable solution: Schedule II

  • 50mg/mL
more...

Hypnotic

2-6 mg/kg IM once; not to exceed 100 mg 

Pre-procedure Sedation

2-6 mg/kg IM, OR 

1-3 mg/kg IV

Not to exceed 100 mg IM

Not recommended; use lower dose if use becomes necessary

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Interactions

Interaction Checker

and pentobarbital

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            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

            Hypoventilation

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            Warnings

            Contraindications

            Barbiturate sensitivity, porphyria liver disease, severe respiratory disease

            Cautions

            General anesthetics and sedation drugs in young children and pregnant women

            • Brain development
              • Prolonged or repeated exposure may result in negative effects on fetal or young children’s brain development
              • Caution with use during surgeries or procedures in children younger than 3 yr or in pregnant women during their third trimester
              • Assess the risk:benefit ratio in these populations, especially for prolonged procedures (ie, >3 hr) or multiple procedures
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            Pregnancy & Lactation

            Pregnancy Category: D

            Lactation: secreted in breast 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

            Depresses sensory cortex & decreases motor activity; produces sedation, drowsiness, and hypnosis

            Pharmacokinetics

            Half-Life: 15-50 hr

            Onset: 10-15 min (IM); 3-5 min (IV)

            Duration: 3-4 hr

            Protein bound: 45-70%

            Vd: 0.8 L/kg (children); 1 L/kg (adults)

            Metabolism: hepatic microsomal enzymes, glucuronidation

            Excretion: Mostly urine

            Enzymes induced: CYP1A2, CYP2C9/10, CYP3A4

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            Administration

            IV Incompatibilities

            Additive: chlorpheniramine, ephedrine, hydrocortisone, hydroxyzine, insulin (regular), levorphanol, norepinephrine, penicillin G potassium, pentazocine, phenytoin, promazine, promethazine, Na bicarb, streptomycin, succinylcholine, thiopental, triflupromazine, vancomycin

            Syringe: butorphanol, chlorpromazine, cimetidine, dimenhydrinate, diphenhydramine, droperidol, fentanyl, glycopyrrolate, hydroxyzine, meperidine, midazolam, morphine, nalbuphine, pentazocine, prochlorperazine, promazine, promethazine, ranitdine

            Y-site: amphotericin B cholSO4, fenoldopam

            Not spec: cefazolin, clindamycin, diazepam, tetracycline

            IV Compatibilities

            Additive: amikacin, aminophylline, CaCl2, chloramphenicol, erythromycin, lidocaine, thiopental, verapamil

            Syringe: aminophylline, atropine (<15 min), ephedrine, hyaluronidase, hydromorphone, neostigmine, scopolamine, Na-bicarb, thiopental

            Y-site: acyclovir, gatifloxacin, insulin, linezolid, propofol

            IV Preparation

            Solution: no further prep needed (available form: 50 mg/mL)

            IV/IM Administration

            IV: slow push; NMT 50 mg/min

            • only when other routes not available

            IM: NMT 5 mL per site; deep into large muscle

            Vials are for multiple use (contains 20 mL=1 g)

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            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.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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