• Hypnotic agent (short-term).
• Preoperative sedation and other situations in which sedation is required.
• Seizures.

Unlabeled Uses:

• IV: Induction of coma in selected patients with cerebral ischemia and management of increased intracranial pressure (high doses).

Contraindicated in:

• Hypersensitivity
• Contains alcohol and propylene glycol and should be avoided in patients with known hypersensitivity or intolerance
• Comatose patients or those with pre-existing CNS depression (unless used to induce coma)
• Uncontrolled severe pain
• OB: Pregnancy (may affect child's brain development when used during 3rd trimester)
• Lactation: Lactation.

Use Cautiously in:

• Severe renal impairment
• Hepatic impairment
• Patients who may be suicidal or who may have been addicted to drugs previously
• Hypovolemic shock
• Pedi: Children <3 yr (may affect brain development)
• Geri: Older adults at ↑ risk of falls (initial dose ↓ recommended).

CV: hypotension.

Derm: rash, urticaria.

GI: constipation, diarrhea, nausea, vomiting.

Local: phlebitis.

MS: arthralgia, myalgia, neuralgia.

Neuro: drowsiness, hangover, lethargy, delirium, depression, excitation, vertigo.

Resp: bronchospasm, LARYNGOSPASM, respiratory depression.
Misc: (INCLUDING ANGIOEDEMA AND SERUM SICKNESS) HYPERSENSITIVITY REACTIONS , physical dependence, psychological dependence.

Drug-Drug:

• Additive CNS depression with other CNS depressants, including alcohol, antihistamines, opioids, and other sedative/hypnotics.
• May ↓ levels and effectiveness of oral contraceptives, warfarin, carbamazepine,chloramphenicol, cyclosporine, dacarbazine, doxycycline, corticosteroids, tricyclic antidepressants, and quinidine.
• May ↑ risk of hepatic toxicity of acetaminophen.
• MAO inhibitors, valproic acid, or divalproex may ↑ levels and ↑ sedation.

Drug-Natural Products:

• Concomitant use of kava, valerian, skullcap, chamomile, or hops can ↑ CNS depression.
• St. John's wort may ↓ levels and effectiveness.

(Generic available)

• Solution for injection: 50 mg/mL;

• IM (Adults): Hypnotic/preoperative sedative: 150–200 mg.
• IM (Children): Sedative: 2–6 mg/kg/day in divided doses. Preoperative sedative: 2–6 mg/kg (up to 100 mg/dose).
• IV (Adults): Hypnotic/anticonvulsant: 100 mg initially; additional small doses may be given every min up to 500 mg total. Induction of coma: 5–7 mg/kg, then 3–4 mg/kg every 3–4 hr dose adjusted by serum level (unlabeled).
• IV (Children): Sedative: 1–3 mg/kg to a maximum of 100 mg until asleep.Conscious sedation: Initial 2 mg/kg, may repeat every 5–10 min with 1–2 mg/kg until adequate sedation achieved. Maximum total dose 6 mg/kg or 150–200 mg.Induction of coma: 10–15 mg/kg slowly over 1–2 hr, followed by a maintenance infusion of 1–3 mg/kg/hr.

Nembutal

• Depresses the CNS, probably by potentiating GABA, an inhibitory neurotransmitter.
• Produces all levels of CNS depression, including the sensory cortex, motor activity, and altered cerebellar function.
• Anticonvulsant effect due to decreased synaptic transmission and increased seizure threshold.
• May decrease cerebral blood flow, cerebral edema, and intracranial pressure (IV only).

• Sedation and/or induction of sleep.

Therapeutic Classification: anticonvulsants, sedative/hypnotics

Pharmacologic Classification: barbiturates

Absorption: IV administration results in complete bioavailability.

Distribution: Widely distributed; highest concentrations in brain and liver. Crosses the placenta; small amounts enter breast milk.

Metabolism/Excretion: Metabolized by the liver. Minimal renal excretion.

Half-life: Children: 25 hr; Adults: 35–50 hr.

Schedule II (C-II)

(sedation)

†Noted as hypnotic effect; sedative effects are longer lasting.

• Explain purpose of pentobarbital to patient and family.
• Discuss the importance of preparing environment for sleep (dark room, quiet, avoidance of nicotine and caffeine).
• May cause daytime drowsiness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
• Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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