methohexital

REMS

Induction of general anesthesia.
Sole anesthesia in short (<15 min), minimally painful procedures.
Supplement to other anesthetic agents.
To produce unconsciousness during balanced anesthesia.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Porphyria.

Use Cautiously in:

Addison’s disease;
Severe anemia;
Severe hepatic impairment;
Severe cardiovascular disease;
Myxedema;
Shock or hypotension;
Pulmonary disease;
Debilitated patients;
Pedi: Children <3 yr (may affect brain development).

Adv. Reactions/Side Effects ⬆ ⬇

CV: CARDIORESPIRATORY ARREST, hypotension

Derm: erythema, pruritus, urticaria

EENT: rhinitis

GI: abdominal pain, hiccups, nausea, salivation, vomiting

Local: pain at IM site, phlebitis at IV site

MS: muscle twitching

Neuro: anxiety, emergence delirium, headache, restlessness, SEIZURES

Resp: APNEA, bronchospasm, coughing, dyspnea, LARYNGOSPASM, respiratory depression

Misc: shivering, allergic reactions

Interactions ⬆ ⬇

Drug-drug:

Additive CNS depression with alcohol, antihistamines, opioid analgesics, and sedative/hypnotics.

Drug-Natural Products:

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

Availability ⬆ ⬇

Powder for injection: 500 mg/vial

Route/Dosage ⬆ ⬇

IV (Adults ): Induction: 1–1.5 mg/kg. Maintenance: 20–40 mg every 4–7 min as intermittent doses or 3 mL of a 0.2% solution/min.
IM (Children >1 mo): Induction: 6.6–10 mg/kg of a 5% solution.
Rect (Children >1 mo): Induction: 25 mg/kg using a 1% solution.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Produces anesthesia by depressing the CNS, probably by potentiating GABA, an inhibitory neurotransmitter.

Therapeutic effects:

Unconsciousness and general anesthesia.

Classifications ⬆ ⬇

Therapeutic Classification: general anesthetics

Pharmacologic Classification: barbiturates

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Accumulates and may be slowly rereleased from lipoid tissues; rapidly crosses the blood-brain barrier.

Metabolism/Excretion: Mostly metabolized by the liver; some metabolism in kidneys and brain. Primarily excreted in the urine.

Half-Life: 1.5–5 hr (↑ in older adults).

Contr. Subst. Schedule ⬆ ⬇

Time/Action Profile ⬆ ⬇

(anesthesia)

ROUTE	ONSET	PEAK	DURATION
IV	within 60 sec	unknown	5–7 min
IM‡	2–10 min	unknown	unknown

‡In pediatric patients.

Patient/Family Teaching ⬆ ⬇

Methohexital may cause psychomotor impairment for 24 hr after administration. Caution patient to avoid driving or other activities requiring alertness for 24 hr.
Advise patient to avoid use of alcohol or other CNS depressants, including opioids, for 24 hr after anesthesia, unless directed by health care professional.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. May cause dose-related fetal heart rate slowing and newborn sedation. These effects can be minimized by using low doses (0.5–1.0 mg/kg).

Pronunciation ⬆ ⬇

Code ⬆

NDC Code

42023- Par Pharmaceutical, Inc.
- 42023-105- Brevital Sodium
  - 42023-105-01- 1 VIAL in 1 CARTON (42023-105-01) > 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL

42023- Par Pharmaceutical, Inc.
- 42023-106- Brevital Sodium
  - 42023-106-01- 1 VIAL in 1 CARTON (42023-106-01) > 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL

section name header

Indications ⬇