Pentobarbital is a barbiturate that acts as a depressant, or sedative, used short-term to treat insomnia. Pentobarbital is also used as an emergency treatment for seizures, and to cause patients to fall asleep for surgery.
Pentobarbital is available under the following different brand names: Nembutal.
Dosages of Pentobarbital
Adult and Pediatric Dosage Forms and Strengths
Injectable solution: Schedule II
50 mg/mL
Dosage Considerations – Should be Given as Follows:
Hypnotic
Adult:
Adult, Initial: 100 mg intravenously (IV) OR 150-200 mg intramuscularly (IM)
May give small increments of drug after at least 1 minute to reach full effect
Not to exceed 500 mg
Pediatric: 2-6 mg/kg IM once; not to exceed 100 mg
Barbiturate Coma
Load: 10-15 mg/kg intravenously (IV) over 30 min; follow by 5 mg/kg IV every 1 hour for 3 doses
Maintenance: 1 mg/kg/hour IV; may increase to 2-4 mg/kg/hour
Renal Failure
Use lower dose
Hepatic Failure
Use lower dose
Pre-procedure Sedation, Pediatric
2-6 mg/kg intramuscularly (IM), OR
1-3 mg/kg intravenously (IV)
Not to exceed 100 mg IM
Other Indications and Uses
Acute convulsive episodes
Dosing Considerations
Geriatric: Not recommended; use lower dose if use becomes necessary
What Are Side Effects Associated with Using Pentobarbital?
Common side effects of pentobarbital include:
Skin swelling (rare)
Slow heart rate
Low blood pressure (hypotension)
Agitation
Loss of balance or coordination
Central nervous system (CNS) depression
Confusion
Dizziness
Fever
Headache
Muscle spasm
Nightmares
Nervousness
Somnolence (frequent)
Fainting
Skin rash
Stevens-Johnson syndrome
Constipation
Nausea
Vomiting
Systemic lupus erythematosus (SLE)
Temporary pause in breathing, especially during sleep (apnea)
Hypoventilation
Problems with memory or concentration
Excitement
Irritability
Aggression (especially in children or older adults)
Drowsiness
“Hangover” effect (drowsiness the day after a dose)
Insomnia
Anxiety
Low blood pressure
Injection site reactions
Agranulocytosis (rare)
Megaloblastic anemia with prolonged use (rare)
Injury of liver with prolonged use (rare)
Serious side effects of Nembutal such as:
Hallucinations
Weak or shallow breathing
Slow heart rate
Weak pulse
Feeling like you might pass out
What Are Warnings and Precautions for Pentobarbital?
Warnings
This medication contains pentobarbital. Do not take Nembutal if you are allergic to pentobarbital or any ingredients contained in this drug.
Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.
Contraindications
Barbiturate sensitivity, porphyria liver disease, severe respiratory disease
Effects of Drug Abuse
None
Short-Term Effects
See “What Are Side Effects Associated with Using Pentobarbital?”
Long-Term Effects
See “What Are Side Effects Associated with Using Pentobarbital?”
Cautions
General anesthetics and sedation drugs in young children and pregnant women
Brain development
Prolonged or repeated exposure may result in negative effects on fetal or young children’s brain development
Caution with use during surgeries or procedures in children younger than 3 years or in pregnant women during their third trimester
Assess the risk:benefit ratio in these populations, especially for prolonged procedures (i.e., greater than 3 hours) or multiple procedures
Pregnancy and Lactation
Do not use pentobarbital in pregnancy. The risks involved outweigh potential benefits. Safer alternatives exist.
Use pentobarbital during pregnancy only in LIFE-THREATENING emergencies when no safer drug is available. There is positive evidence of human fetal risk.
Pentobarbital is secreted in breast milk; use caution if breastfeeding.
https://www.rxlist.com/pentobarbital/generic-drug.htm
