Pentobarbital Sodium

A to Z Drug Facts

Pentobarbital Sodium

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(pen-toe-BAR-bih-tahl SO-dee-uhm)

Nembutal Sodium, Nova Rectal

Class: Sedative and hypnotic/Barbiturate/Short-acting/Anticonvulsant

Action Depresses sensory cortex, decreases motor activity, alters cerebellar function and produces drowsiness, sedation and hypnosis.

Indications Sedation; short-term treatment of insomnia; preanesthesia; emergency control of convulsions (parenteral form).

Contraindications Hypersensitivity to barbiturates; manifest or latent porphyria.

Route/Dosage

Insomnia

ADULTS: PO/IV 100 mg (maximum IV rate 50 mg/min). IM/PR 120 to 200 mg (maximum IM dose 500 mg or 5 ml volume regardless of concentration).

Sedation

ADULTS: PO/PR 20 to 30 mg bid to qid. CHILDREN: PO/IM 2 to 6 mg/kg (maximum 100 mg). IV 50 mg.

Convulsions

ADULTS: IV Use minimum dose to avoid compounding depression. Administer slowly to allow time for drug to penetrate the blood-brain barrier. Do not exceed 50 mg/min.

Pediatric Patients Unable to Take Orally or by Injection

CHILDREN 12 to 14 YR (36.4 to 50 KG): PR 60 or 120 mg. CHILDREN 5 to 12 YR (18.2 to 36.4 KG) PR 60 mg. CHILDREN 1 to 4 YR (9 to 18.2 KG): PR 30 or 60 mg. CHILDREN 2 mo to 1 YR (4.5 to 9 KG): PR 30 mg.

Interactions

Alcohol, CNS depressants: May produce additive depressant effects. Anticoagulants, beta-blockers, calcium-channel blockers (eg, nifedipine, verapamil), theophylline: Activity of these drugs may be reduced. Anticonvulsants: Serum concentrations of carbamazepine, valproic acid and succinimides may be reduced. Valproic acid may increase barbiturate serum levels. Corticosteroids: Effectiveness may be reduced. Estrogen, estrogen-containing oral contraceptives: May cause decreased contraceptive and estrogen effect. Griseofulvin: Decreased griseofulvin levels.

Lab Test Interferences Decreased serum bilirubin concentrations, false-positive phentolamine test, decreased response to metyrapone and impaired absorption of radioactive cyanocobalamin.

Adverse Reactions

CV: Bradycardia; hypotension; syncope. CNS: Drowsiness; agitation; confusion; headache; hyperkinesia; ataxia; CNS depression; paradoxical excitement; nightmares; psychiatric disturbances; hallucinations; insomnia; dizziness. GI: Nausea; vomiting; constipation. HEPA: Liver damage. HEMA: Blood dyscrasias (eg, agranulocytosis, thrombocytopenia). RESP: Hypoventilation; apnea; laryngospasm; bronchospasm. OTHER: Hypersensitivity reactions (eg, angioedema, rashes, exfoliative dermatitis); fever; injection site reactions (eg, local pain, thrombophlebitis).

Precautions

Pregnancy: Category D. Lactation: Excreted in breast milk. Children: May respond with excitement rather than depression. Elderly patients: More sensitive to drug effects; dosage reduction is required. Dependence: Tolerance or psychological and physical dependence may occur with continued use. IV administration: Do not exceed maximum IV rate; respiratory depression, apnea and hypotension may result. Parenteral solutions are highly alkaline; extravasation may cause tissue damage and necrosis. Inadvertent intra-arterial injection may lead to arterial spasm, thrombosis, and gangrene. Renal or hepatic impairment: Use drug with caution; dosage reduction may be required. Seizure disorders: Status epilepticus may result from abrupt discontinuation.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Give IM injections deeply into large muscle. Do not exceed maximum IM dose of 500 mg or 5 ml of volume (regardless of concentration).
For IV administration, inject into large vein; do not exceed maximum IV rate of 50 mg/min, do not administer into artery and do not allow perivascular extravasation.
Administer with caution to patients with history of substance abuse.
Do not use as sleep aid for > 2 wk.
Store parenteral form at room temperature. Do not use if discolored or if precipitate forms.
Store suppositories in refrigerator. Do not divide.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies. Note presence of liver disease, respiratory disease, and porphyria.
Observe for common side effects such as sedation or dizziness and report to physician.
With prolonged therapy monitor lab test results for liver, renal, and hematopoietic functions.
Monitor patient carefully during IV use for potential respiratory depression.
Assess infants of lactating mothers and report drowsiness to physician.
In children, monitor for possible paradoxical response of increased agitation and report to physician.
Notify physician of the following signs of barbiturate intoxication: Unsteady gait, slurred speech, confusion or irritability.
Watch for behavior indicative of drug dependency such as inordinate requests for more medication or need to refill prescription early.

OVERDOSAGE: SIGNS & SYMPTOMS
	CNS and respiratory depression, Cheyne-Stokes respiration, areflexia, constriction of pupils, oliguria, tachycardia, hypotension, lowered body temperature, coma, apnea, circulatory collapse, respiratory arrest, death

Patient/Family Education

Warn patient that medication may be habit forming and for this reason it is important to take medicine as directed. Taking too little or too much can have serious complications.
Instruct patient to report the following symptoms to physician: Nausea, vomiting, drowsiness, dizziness, fever, sore throat, mouth sores, easy bleeding, bruising, skin irritation, or exaggerated sunburn.
Caution patient to avoid intake of alcoholic beverages or other CNS depressants.
Advise patient that drug may cause drowsiness, and to use caution while driving or performing other tasks requiring mental alertness.