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(see-koe-BAR-bih-tahl SO-dee-uhm)
Seconal Sodium Pulvules
Class: Sedative and hypnotic/barbiturate

 Action Depresses sensory cortex, decreases motor activity, alters cerebellar function and produces drowsiness, sedation and hypnosis.

 Indications Short-term (up to 2 wk) treatment of insomnia; induction of basal hypnosis before anesthesia (parenteral form); sedation (parenteral form). Unlabeled use(s): Control of status epilepticus or acute seizure episodes.

 Contraindications Hypersensitivity to barbiturates; history of addiction to sedative/hypnotic drugs; history of porphyria; severe liver impairment; respiratory disease with dyspnea; nephritic patients.

 Route/Dosage

Insomnia

ADULTS: PO At bedtime 100 mg.

Hypnotic

ADULTS: IM 100 to 200 mg; IV 50 to 250 mg.

Sedation

ADULTS: PO 30 to 50 mg tid or qid. CHILDREN: PO/PR 2 to 6 mg/kg. For rectal administration, dilute to 1% to 1.5% solution.

Preoperative Sedation

ADULTS: PO 200 to 300 mg 1 to 2 hr before surgery. CHILDREN: PO 2 to 6 mg/kg (maximum 100 mg) 1 to 2 hr before surgery.

Sedation/Preanesthesia

ADULTS: IM (light sedation) 1 mg/kg 15 min before procedure. CHILDREN: IM 4 to 5 mg/kg.

Convulsions

ADULTS: IM/IV 1.1 to 2.2 mg/kg. Maximum IV rate 50 mg/15 sec. Maximum adult IM dose 500 mg or 5 ml volume regardless of concentration.

 Interactions

Alcohol, CNS depressants: May produce additive CNS depressant effects. Anticoagulants (eg, warfarin), betablockers (eg, metoprolol, propranolol), verapamil, quinidine, theophyllines: May reduce activity of these drugs. Anticonvulsants: May reduce serum concentrations of carbamazepine, valproic acid and succinimides. Valproic acid may increase barbiturate serum levels. Corticosteroids: May reduce effectiveness of corticosteroids. Estrogens, estrogen-containing oral contraceptives: May reduce contraceptive effect and estrogen effect.

 Lab Test Interferences May increase bromsulphalein retention; may cause decreased serum bilirubin concentrations; false-positive phentolamine test results; decreased response to metyrapone; impaired absorption of radioactive cyanocobalamin.

 Adverse Reactions

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. HEMA: Blood dyscrasias (eg, agranulocytosis, thrombocytopenia). RESP: Hypoventilation; apnea; laryngospasm; bronchospasm. OTHER: Hypersensitivity reactions (eg, angioedema, rashes, exfoliative dermatitis); fever; liver damage; injection site reactions (eg, local pain, thrombophlebitis).

 Precautions

Pregnancy: Category D. Lactation: Excreted in breast milk. Children: May respond with excitement rather than depression. Elderly or debilitated 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 50 mg/15 sec; 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

 Administration/Storage

  • Administer on empty stomach with full glass of water to enhance absorption. Tablet may be crushed and mixed with food or swallowed whole.
  • For insomnia, give ½ to 1 hr before bedtime.
  • Check to see that medication is swallowed.
  • For IM administration: inject deep into large muscle using Z-track technique to diminish tissue irritation and potential sloughing. Do not inject subcutaneously. Do not exceed 5 ml at any 1 site. Rotate injection sites.
  • For direct IV administration, may give undiluted or diluted with Sterile Water for Injection, normal saline (0.9% Sodium Chloride) or Ringer’s solution. Do not use lactated Ringer’s solution.
  • Administer intravenously no faster than 50 mg/15 sec; too rapid administration can cause respiratory depression and hypotension. Have resuscitative equipment readily available.
  • Use diluted solution within 30 min of mixing. Rotate, do not shake vial.
  • For rectal administration in children preoperatively, after cleansing enema, give diluted parenteral solution (1% to 1.5%) as ordered.
  • Store oral preparation at room temperature. Refrigerate parenteral form. Use only clear solution; discard if precipitate forms or solution becomes cloudy.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies. Note history of respiratory disease with dyspnea or hypersensitivity to barbiturates or sedative/hypnotic drug addiction.
  • Assess type of sleep difficulty: falling asleep, remaining asleep.
  • Assess sleep pattern prior to and during therapy.
  • Assess vital signs q 15 to 30 min after parenteral administration for 2 hr and then prn.
  • Assess mental status: sensorium, affect, mood and long-term and short-term memory.
  • Obtain baseline Hct, Hgb, RBC and liver function test results (transaminase levels and bilirubin). Periodically evaluate those results if patient is on long-term therapy.
  • Provide safety measures (removal of cigarettes, side rails up, night light, easily accessible call-bell) and assistance with ambulation.

OVERDOSAGE: SIGNS & SYMPTOMS
  CNS and respiratory depression, Cheyne-Stokes respiration, areflexia, oliguria, tachycardia, hypotension, lowered body temperature, coma, pulmonary edema, death

 Patient/Family Education

  • Explain that this medication may cause psychological and physical dependence. Emphasize that it is important not to increase dose without consulting physician.
  • Discuss ways to facilitate sleep (quiet, darkened room; avoidance of caffeine and nicotine; warm bath, warm milk; deep breathing; relaxation; self-hypnosis).
  • Inform patient that it may take a few doses to achieve noticeable sleep benefit.
  • Instruct patient to notify physician immediately of sudden onset of fever, sore throat, bruising, rash, jaundice, or unusual bleeding (eg, epistaxis).
  • Instruct patient to avoid intake of alcoholic beverages or other CNS depressants (eg, pain relievers, antihistamines, sedatives) to prevent serious CNS depression.
  • Emphasize importance of follow-up evaluation with physician to monitor progress of therapy.
  • Inform patient that after discontinuation of drug, nighttime sleeping might be disturbed for a few days and increased dreaming may occur.
  • Advise patient that drug may cause daytime drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
  • Instruct patient not to discontinue medication abruptly without consulting physician.

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