Methohexital
BREVITAL
“Briefly vital Metal hexapod”
barbs → barbiturate
What it isUltra-short-acting barbiturate that potentiates GABA-A; IV induction agent for anesthesia and brief procedures, especially ECT.
Why this oneRapid onset and recovery with less seizure suppression than propofol, so it preserves ECT seizure quality.
What limits itCauses apnea, laryngospasm, and cardiovascular depression; use only with continuous cardiorespiratory monitoring and immediate airway rescue.
FDA-approved for
- induction of anesthesia (1960)
FDA label
Read the full label on DailyMed ↗
BOXED WARNING Use only in settings providing continuous respiratory (pulse oximetry) and cardiac monitoring, with resuscitative drugs/equipment and trained personnel immediately available; a dedicated monitor other than the proceduralist for deeply sedated patients.
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Induction of anesthesia / sedation | adult | Individualized by route (IV, IM, rectal, continuous drip); prepare 1% solution for intermittent IV/rectal, 0.2% for continuous IV, 5% for IM | titrated to effect | titrated to effect |
Renal Undefined
Hepatic Undefined
Instructions
- Follow dilution instructions exactly; freshly prepare and use promptly (stable 24 h at room temp)
- Use bacteriostatic-free diluent
- Do NOT use Lactated Ringer’s (incompatible)
- Ensure facilities for ventilation and oxygen; observe carefully during and after use
Available strengths
- inj 500 mg
Contraindications
- Patients in whom general anesthesia is contraindicated
- Latent or manifest porphyria
- Known hypersensitivity to barbiturates
Cautions
- Cardiorespiratory arrest may occur — continuous monitoring required
- Respiratory depression/apnea, laryngospasm, bronchospasm
- Circulatory/myocardial depression, hypotension
- Skeletal muscle hyperactivity (twitching), seizures
Adverse reactions
- Respiratory depression (incl. apnea), laryngospasm, bronchospasm, hiccups
- Circulatory depression, hypotension, tachycardia, thrombophlebitis
- Skeletal muscle twitching, seizures
- Emergence delirium, restlessness, anxiety
- Nausea, emesis, abdominal pain
- Injection-site pain, anaphylaxis (rare)
Pregnancy Undefined
Lactation Undefined
Cost
Methohexital (BREVITAL)
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 500 mg | inj | per unit | not offered |
NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Methohexital is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.
Generic entryBy 2023
⚠ BOXED WARNING
- Use only where continuous respiratory and cardiac monitoring, resuscitation equipment, and airway-skilled personnel are immediately available.
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityApnea, hypotension and loss of protective reflexes require continuous monitoring and airway capability.