Pentobarbital Sodium
| (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.
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.
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.
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).
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 |
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- 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.
- 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.
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- 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.
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