Generic Name

Glutethimide

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Classification

FDA Approved Indications

• Short-term management of insomnia

Mechanism of Action

Glutethimide depresses the central nervous system by enhancing the action of gamma-aminobutyric acid (GABA) at GABA-A receptors, leading to sedative and hypnotic effects.

Dosage and Administration

Adult: Initial dose: 300 mg at bedtime; dose may be adjusted up to 900 mg per day in divided doses.

Pediatric: Not recommended due to lack of safety data.

Geriatric: Start with lower doses due to increased sensitivity and risk of adverse effects.

Renal Impairment: Use with caution; adjust dose if necessary based on renal function.

Hepatic Impairment: Use cautiously as hepatic metabolism may be impaired.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed; crosses the blood-brain barrier.

Metabolism: Metabolized in the liver, primarily via hydroxylation and conjugation.

Excretion: Excreted in the urine as metabolites.

Half Life: Approximately 4-6 hours.

Contraindications

• Hypersensitivity to glutethimide or other sedative-hypnotics.
• History of substance abuse.

Precautions

• Use with caution in patients with respiratory disorders, hepatic or renal impairment, or a history of addiction.
• Monitor for development of dependence and withdrawal symptoms.

Adverse Reactions - Common

• Drowsiness, dizziness (Common)
• Nausea, vomiting (Less common)

Adverse Reactions - Serious

• Respiratory depression (Rare)
• Dependence and withdrawal symptoms (Rare)
• Psychoses, hallucinations (Rare)

Drug-Drug Interactions

• Other CNS depressants, including alcohol, opioids, and antihistamines (increased sedation)
• Cimetidine or other drugs affecting hepatic metabolism (altered glutethimide levels)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Use exactly as prescribed; do not increase dose.
• Caution regarding drowsiness; avoid driving or operating heavy machinery.
• Warn about potential for dependence.
• Advise against alcohol or other CNS depressants.

Special Considerations

Black Box Warnings:

• Potential for addiction, abuse, and overdose.
• Use with caution, particularly with other CNS depressants.

Genetic Factors: None well established.

Lab Test Interference: None known.

Overdose Management

Signs/Symptoms: Severe sedation, respiratory depression, coma.

Treatment: Supportive care, airway management, gastric lavage if recent ingestion, activated charcoal, and symptomatic treatment. Educate about the risk of overdose especially with concurrent CNS depressants.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable under recommended storage conditions.