Home Drug Guide Pentobarbital Sodium

Drug Guide

Generic Name

Pentobarbital Sodium

Brand Names Sodium Pentobarbital, Nembutal Sodium, Nembutal

Classification

Therapeutic: Sedative-Hypnotic, Anxiolytic, Anticonvulsant

Pharmacological: Barbiturate

FDA Approved Indications

Short-term treatment of insomnia
Sedation before procedures
Control of seizures in certain epilepsy syndromes

Mechanism of Action

Pentobarbital enhances the activity of GABA at GABA_A receptors, leading to increased chloride ion influx, hyperpolarization of neurons, and central nervous system depression.

Dosage and Administration

Adult: Dosage varies depending on indication; for sedation, typically 100-200 mg IV or IM; consult specific protocols.

Pediatric: Use with caution; dosing based on weight and clinical response.

Geriatric: Start at lower doses due to increased sensitivity; monitor closely.

Renal Impairment: Dosage adjustment may be necessary; consult clinical guidelines.

Hepatic Impairment: Use with caution; metabolism may be impaired, requiring dosage reduction.

Pharmacokinetics

Absorption: Well absorbed IM and IV.

Distribution: Widely distributed; crosses blood-brain barrier and placenta.

Metabolism: Metabolized in the liver, mainly by oxidation.

Excretion: Excreted in urine, mostly as inactive metabolites.

Half Life: 4-16 hours, depending on dose, patient age, and hepatic function.

Contraindications

Hypersensitivity to barbiturates
Respiratory depression
Porphyria

Precautions

Use with caution in pregnant women, lactating women, patients with history of substance abuse, hepatic or renal impairment, or respiratory conditions. Potential for dependence and abuse.

Adverse Reactions - Common

Drowsiness (Common)
Dizziness (Common)
Respiratory depression (Uncommon)

Adverse Reactions - Serious

Circulatory collapse (Rare)
Dependence and tolerance (Common)
Suicidal ideation (Rare)

Drug-Drug Interactions

Other CNS depressants (additive sedation or respiratory depression)
CNS-active medications (anticonvulsants, antidepressants)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor vital signs, level of consciousness, respiratory function.

Diagnoses:

Risk for respiratory depression
Impaired sleep pattern

Implementation: Use the lowest effective dose; monitor patient response.

Evaluation: Assess effectiveness of sedation or seizure control, monitor for adverse reactions.

Patient/Family Teaching

Avoid alcohol and other CNS depressants.
Do not operate heavy machinery or drive.
Report any excessive drowsiness, confusion, or respiratory difficulties.

Special Considerations

Black Box Warnings:

Risk of respiratory depression, coma, and death when used improperly or in combination with other CNS depressants.

Genetic Factors: N/A

Lab Test Interference: N/A

Overdose Management

Signs/Symptoms: Marked drowsiness, respiratory depression, coma, hypotension.

Treatment: Supportive care: maintain airway and breathing, activated charcoal if within 1 hour of ingestion, hemodialysis in severe cases, administer overdose-specific medications under medical supervision.

Storage and Handling

Storage: Store in a secure, locked cabinet at room temperature, away from light and moisture.

Stability: Stable under proper storage conditions for the shelf life specified by the manufacturer.