Pentobarbital
NEMBUTAL
What it isShort-acting barbiturate GABA-A positive modulator used for anesthesia and, by continuous IV infusion, burst suppression in refractory status epilepticus.
Why this oneProduces rapidly titratable deep cerebral suppression when benzodiazepines and standard antiseizure drugs have failed.
What limits itProfound hypotension and respiratory depression are common at coma doses, with accumulation during prolonged infusion; it also induces hepatic enzymes.
FDA-approved for
- sedation / anticonvulsant emergency use
Off-label
- refractory status epilepticus (barbiturate coma)
- raised intracranial pressure
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Sedative/hypnotic (IM) | adult | 150-200 mg single IM injection | ||
| Sedative/hypnotic (IM) | pediatric | 2-6 mg/kg single IM injection | 100 mg | |
| Sedative/hypnotic (IV) | adult (70 kg) | 100 mg | additional small increments as needed | 200-500 mg total |
Renal Reduce dose in impaired renal function.
Hepatic Reduce dose in hepatic disease.
IV rate must not exceed 50 mg/min; give in fractional doses and wait >=1 min to judge effect.
Instructions
- Individualize dose; use parenteral route only when oral is impossible/impractical
- IM: inject deeply into a large muscle, <=5 mL per site
- IV: inject slowly, rate <=50 mg/min, in fractional doses with vital-sign monitoring and resuscitation available
- Reduce dose in elderly or debilitated patients
Available strengths
- inj 50 mg/mL
Contraindications
- History of manifest or latent porphyria
Cautions
- Respiratory depression, hypoventilation, apnea (especially with rapid IV administration)
- Physical dependence and withdrawal with prolonged use
- Additive CNS depression with alcohol and other CNS depressants
- Reduce dose in elderly, debilitated, hepatic, or renal impairment
- Pediatric neurotoxicity with prolonged anesthetic/sedative exposure
Adverse reactions
- Somnolence
- Agitation, confusion, ataxia, hallucinations, nightmares
- Hypoventilation, apnea
- Bradycardia, hypotension, syncope
- Nausea, vomiting, constipation
- Injection-site reactions; hypersensitivity (angioedema, rash, exfoliative dermatitis)
Pregnancy In-utero exposure can cause neonatal withdrawal (seizures, hyperirritability); potential neuroapoptosis with prolonged 3rd-trimester exposure.
Lactation Undefined
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 50 mg/mL | inj | per unit | not offered |
Generic entryPre-1982
NO BOXED WARNINGS
Principal riskprofound respiratory and cardiovascular depression
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilitySedation, dizziness and agent-specific rash, behavioral, hepatic, hematologic or teratogenic toxicity.