Nembutal Sodium (pentobarbital sodium)

Dosage of pentobarbital sodium must be individualized for each patient, taking into consideration the patient's age, weight, and condition. Dosage of pentobarbital sodium is expressed in terms of the sodium salt.

Pentobarbital sodium may be administered by deep IM or slow IV injection. The drug also has been administered as a continuous IV infusion+ in the treatment of refractory status epilepticus; administration by continuous IV infusion requires assisted ventilation and cardiovascular monitoring.. IV administration of pentobarbital should usually be reserved for acute treatment, when other routes of administration are not feasible or immediate onset is necessary.

Because parenteral pentobarbital solution is highly alkaline, extreme caution should be taken to avoid perivascular extravasation or accidental intra-arterial injection of the drug. Extravascular injection of pentobarbital can cause local tissue damage and subsequent necrosis, while intra-arterial injection can lead to transient pain, or in severe cases, gangrene of the limb. If complaints of limb pain occur in patients receiving pentobarbital injection, the injection should be stopped.

Pentobarbital sodium injection should be stored at 20-25degreesC (excursions permitted from 15-30degreesC); freezing and exposure of the injection to extreme heat should be avoided. The drug should not be used if there is discoloration or precipitation.

No dosing information is available for this tab.

No dosing information is available for this tab.

Pentobarbital is metabolized by, and induces hepatic microsomal enzymes. Although most reported drug interaction experience has involved the use of phenobarbital, these interactions are applicable to other barbiturates such as pentobarbital.

There are no contraindication interactions for this drug.

There are no severe interactions for this drug.

There are no moderate interactions for this drug.

*Known hypersensitivity to barbiturates.

*History of manifest or latent porphyria.

There are no contraindication contraindications for this drug.

There are no severe contraindications for this drug.

There are no moderate contraindications for this drug.

The most common adverse effect reported in up to 3% of patients receiving pentobarbital is somnolence. Other less common adverse effects reported in <1% of patients receiving pentobarbital include agitation, confusion, hyperkinesia, ataxia, CNS depression, nightmares, nervousness, psychiatric disturbance, hallucinations, insomnia, anxiety, dizziness, thinking abnormalities, hypoventilation, apnea, bradycardia, hypotension, syncope, nausea and vomiting, constipation, headache, injection site reactions, hypersensitivity reactions (angioedema, skin rash, exfoliative dermatitis), fever, liver damage, and megaloblastic anemia (following chronic use).

There are no severe adverse reactions for this drug.

There are no less severe adverse reactions for this drug.

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Animal data indicate that use of anesthetic and sedation drugs, including pentobarbital, that block NMDA receptors and/or potentiate GABA activity leads to increased neuronal apoptosis in the developing brain and results in long-term cognitive deficits when administered for >3 hours. Although the clinical importance of these findings have not been fully elucidated, the window of vulnerability to these neurodevelopmental changes is thought to correlate with exposure during the third trimester of pregnancy through the first year of life in humans, but may extend to approximately 3 years of age.

Some published evidence suggests that similar deficits in cognition and behavior may occur in children following repeated or prolonged exposure to anesthesia early in life, although there are substantial limitations to this data.

Anesthetic and sedation drugs are an essential component of care for children who require surgery or other procedures that cannot be delayed; no specific general anesthetic or sedation drug has been shown to be safer than any other such drug. When procedures requiring the use of general anesthetics or sedation drugs are considered for young children, clinicians should take into consideration the benefits, risks (including potential risk of adverse neurodevelopmental effects), and appropriate timing and duration of the procedure.

Based on animal data, repeated or prolonged use of general anesthetics and sedatives, including pentobarbital sodium, during the third trimester of pregnancy may result in adverse neurodevelopmental effects in the fetus. The clinical importance of these animal findings to humans is not known; the potential risk of adverse neurodevelopmental effects should be considered and discussed with pregnant women undergoing procedures requiring general anesthetics and sedation drugs.

Infants with long-term exposure to barbiturates in utero may exhibit an immediate or delayed onset of withdrawal symptoms (e.g., seizures, hyperirritability) up to 14 days after birth.

If pentobarbital is administered during pregnancy, or the patient becomes pregnant while receiving the drug, the patient should be informed of the potential fetal hazard.

Because barbiturates such as pentobarbital are excreted into the milk in small amounts, caution should be exerted when barbiturates are administered to nursing women.

Because geriatric patients may be more sensitive to barbiturates, the manufacturer recommends reducing the dosage of pentobarbital sodium.

In general, dosage selection for geriatric patients should be undertaken with caution and started at the lower end of the dosage range, taking into account the greater frequency of reduced hepatic, renal, or cardiac function and of concomitant diseases or drug therapy.

Clinical studies of pentobarbital did not include a sufficient number of patients >=65 years of age to assess differences compared to younger adults. Other reported clinical experiences with pentobarbital have also not identified differences in response between geriatric and younger adult patients.

Geriatric patients may be more sensitive to barbiturate therapy, and may frequently react to barbiturates with excitement, confusion, or depression.