Pentobarbital

Administration

• Type: Anticonvulsant, Barbiturate; Barbiturate
• Routes of Administration: IV, IM
• Common Trade Names: Nembutal

Adult Dosing

• Procedural sedation: 150-200 mg IM x1
  • Onset 10-15min IM; duration 1-4h IM

• Barbiturate coma: 1-3 mg/kg/h IV
  • Start: 10-15 mg/kg IV x1, then 1 mg/kg/h IV
  • Taper dose gradually to D/C if long-term use

Pediatric Dosing

• Procedural sedation: 2-6 mg/kg IM x1
  • Max: 100 mg/dose
  • Onset: 10-15min IM, 1min IV; duration: 1-4h IM, 15min IV

• Barbiturate coma: 1-3 mg/kg/h IV
  • Start: 10-15 mg/kg IV x1, then 1 mg/kg/h IV
  • Taper dose gradually to D/C if long-term use

Special Populations

• Pregnancy Risk Factor: D

Renal Dosing

• Renal impairment: decrease start dose

Hepatic Dosing

• Hepatic impairment: decrease start dose

Contraindications

• Allergy to class/drug
• depressed respiratory fxn
• porphyria
• avoid abrupt withdrawal (long-term use)

Adverse Reactions

Serious

• respiratory depression
• Stevens-Johnson syndrome
• angioedema
• lupus erythematosus

Common

• somnolence
• agitation
• confusion
• hyperkinesia
• ataxia
• CNS depression

Pharmacology

• Half-life: 15-50 hrs
• Metabolism: CYP450
• Excretion: Urine

Mechanism of Action

alters sensory cortex, cerebellar, and motor activities; produces sedation, hypnosis, and anesthesia

References

<Epocrates>