Secobarbital

SECONAL

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Pronunciation: see-koe-BAR-bi-tal

Secobarbital ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Secobarbital ballicule

Secobarbital SECONAL mascot mnemonic cartoon — Visual mnemonic: Secobarbital mascot
**“Second barb”**

What it isShort-acting barbiturate; insomnia, and in some jurisdictions medical aid in dying.

Why this oneRapid, reliable sedation.

What limits itBarbiturate dependence, a narrow margin and lethal overdose. Schedule II; largely obsolete as a hypnotic.

Secobarbital molecular structure (skeletal formula) — Molecular structure: Secobarbital

FDA label

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FDA dosing	Population	Start	Target	Max
Insomnia (hypnotic, short-term)	Adults	100 mg QHS	100 mg QHS	100 mg QHS
Preanesthetic	Adults	200-300 mg 1-2 h before surgery	200-300 mg preop	300 mg
Preanesthetic	Pediatric	2-6 mg/kg preop	2-6 mg/kg	100 mg

Renal Reduce dose (impaired renal function)

Hepatic Reduce dose; contraindicated in marked liver impairment

Instructions

Individualize dose by age, weight, condition
Reduce dose in elderly or debilitated patients
Withdraw gradually after prolonged use to avoid withdrawal (delirium, convulsions)

Available strengths

cap 100 mg

Contraindications

History of manifest or latent porphyria
Marked impairment of liver function
Respiratory disease in which dyspnea or obstruction is evident

Cautions

Habit-forming; tolerance, psychological and physical dependence
Abrupt cessation after prolonged use may cause withdrawal (delirium, convulsions, death)
Complex sleep behaviors (sleep-driving)
Caution in acute or chronic pain (paradoxical excitement/masked symptoms)
Additive CNS depression with alcohol/other CNS depressants
Caution in mentally depressed/suicidal/history of drug abuse

Adverse reactions

Somnolence
Agitation
Confusion
Ataxia
Hypoventilation/apnea
Bradycardia
Hypotension
Nausea
Vomiting
Hypersensitivity reactions

Pregnancy Pregnancy Category D — can cause fetal harm; withdrawal in infants exposed in last trimester

Lactation Small amounts excreted in milk; exercise caution in nursing women

Cost

Secobarbital (SECONAL)

Strength		#/mo	generic $/mo	CostPlus
100 mg	cap	30 qd		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Secobarbital is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

NO BOXED WARNINGS

Principal riskDependence and lethal overdose; a narrow margin

Classes and tags

Clinical profile

Therapeutic safety burden3 / 4

Overdose danger3 / 4

Sedation liability3 / 4

Direct muscarinic antagonism0 / 4

Legacy pregnancy categoryD

Defining liabilityDependence and potentially fatal respiratory-depressant overdose

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