Pentobarbital

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Pentobarbital Brand Name– Nembutal

What is Pentobarbital

Pentobarbital is a short-acting oral and parenteral barbiturate. It has sedative-hypnotic and anticonvulsant properties, and is used primarily in the short-term treatment of insomnia.

Other uses include sedation induction; relief of preoperative anxiety; control of status epilepticus or seizures resulting from meningitis, tetanus, alcohol withdrawal, poisons, chorea, or eclampsia; and induction of coma in the management of cerebral ischemia and increased intracranial pressure that may follow stroke or head trauma.

Pentobarbital was approved by the FDA in 1939.

Indications

  1. agitation
  2. anxiety
  3. head trauma
  4. increased intracranial pressure
  5. insomnia
  6. procedural sedation
  7. sedation maintenance
  8. status epilepticus

For procedural sedation or for use as a preanesthetic medication

Side Effects

  1. agitation
  2. agranulocytosis
  3. angioedema
  4. anxiety
  5. aplastic anemia
  6. apnea
  7. asthenia
  8. ataxia
  9. bradycardia
  10. bronchospasm
  11. bullous rash
  12. confusion
  13. constipation
  14. diaphoresis
  15. dizziness
  16. drowsiness
  17. ecchymosis
  18. elevated hepatic enzymes
  19. emotional lability
  20. erythema
  21. exfoliative dermatitis
  22. fever
  23. hallucinations
  24. headache
  25. hepatitis
  26. hyperkinesis
  27. hypotension
  28. hypoventilation
  29. impaired cognition
  30. impotence (erectile dysfunction)
  31. injection site reaction
  32. insomnia
  33. interstitial nephritis
  34. intraventricular hemorrhage
  35. irritability
  36. jaundice
  37. lactic acidosis
  38. lethargy
  39. libido decrease
  40. lupus-like symptoms
  41. maculopapular rash
  42. megaloblastic anemia
  43. miosis
  44. mydriasis
  45. nausea
  46. neutropenia
  47. nightmares
  48. nystagmus
  49. osteomalacia
  50. osteopenia
  51. phlebitis
  52. photosensitivity
  53. physiological dependence
  54. porphyria
  55. psychomotor impairment
  56. ptosis
  57. purpura
  58. rash
  59. renal failure (unspecified)
  60. respiratory depression
  61. seizures
  62. serum sickness
  63. sinus tachycardia
  64. Stevens-Johnson syndrome
  65. syncope
  66. tachypnea
  67. thrombocytopenia
  68. tissue necrosis
  69. toxic epidermal necrolysis
  70. urticaria
  71. vertigo
  72. vomiting
  73. weakness
  74. withdrawal

Monitoring Parameters

  • CBC
  • LFTs

Contraindications

  • abrupt discontinuation
  • agranulocytosis
  • alcoholism
  • barbiturate hypersensitivity
  • breast-feeding
  • carbamazepine hypersensitivity
  • cardiac disease
  • children
  • chronic obstructive pulmonary disease (COPD)
  • CNS depression
  • coadministration with other CNS depressants
  • driving or operating machinery
  • ethanol ingestion
  • geriatric
  • heart failure
  • hepatic disease
  • hepatic encephalopathy
  • hydantoin hypersensitivity
  • hypertension
  • hypotension
  • infants
  • intraarterial administration
  • intravenous administration
  • labor
  • neonates
  • obstetric delivery
  • osteomalacia
  • osteoporosis
  • pain
  • porphyria
  • pregnancy
  • premature neonates
  • pulmonary disease
  • renal impairment
  • respiratory depression
  • shock
  • sleep apnea
  • subcutaneous administration
  • substance abuse

Interactions

  • Abemaciclib
  • Acetaminophen
  • Acetaminophen; Aspirin, ASA; Caffeine
  • Acetaminophen; Butalbital
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Codeine
  • Acetaminophen; Dextromethorphan
  • Acetaminophen; Dextromethorphan; Doxylamine
  • Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
  • Acetaminophen; Dextromethorphan; Phenylephrine
  • Acetaminophen; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Dichloralphenazone; Isometheptene
  • Acetaminophen; Diphenhydramine
  • Acetaminophen; Guaifenesin; Phenylephrine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Acetaminophen; Pentazocine
  • Acetaminophen; Propoxyphene
  • Acetaminophen; Pseudoephedrine
  • Acetaminophen; Tramadol
  • Acetazolamide
  • Acrivastine; Pseudoephedrine
  • Aldesleukin, IL-2
  • Alfentanil
  • Aliskiren; Amlodipine
  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Aliskiren; Hydrochlorothiazide, HCTZ
  • Alprazolam
  • Altretamine
  • Amiloride; Hydrochlorothiazide, HCTZ
  • Aminosalicylate sodium, Aminosalicylic acid
  • Amitriptyline; Chlordiazepoxide
  • Amlodipine
  • Amlodipine; Atorvastatin
  • Amlodipine; Benazepril
  • Amlodipine; Celecoxib
  • Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amlodipine; Olmesartan
  • Amlodipine; Telmisartan
  • Amlodipine; Valsartan
  • Amoxapine
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Amphetamine
  • Amphetamine; Dextroamphetamine
  • Amphetamine; Dextroamphetamine Salts
  • Amprenavir
  • Anagrelide
  • Apomorphine
  • Apraclonidine
  • Apremilast
  • Aprepitant, Fosaprepitant
  • Aripiprazole
  • Armodafinil
  • Artemether; Lumefantrine
  • Asenapine
  • Aspirin, ASA
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
  • Aspirin, ASA; Dipyridamole
  • Aspirin, ASA; Omeprazole
  • Aspirin, ASA; Oxycodone
  • Aspirin, ASA; Pravastatin
  • Atenolol; Chlorthalidone
  • Atorvastatin
  • Atorvastatin; Ezetimibe
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Atropine; Difenoxin
  • Atropine; Diphenoxylate
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Avanafil
  • Avapritinib
  • Avatrombopag
  • Axitinib
  • Azelastine
  • Azelastine; Fluticasone
  • Azilsartan; Chlorthalidone
  • Bedaquiline
  • Belladonna; Opium
  • Benazepril; Hydrochlorothiazide, HCTZ
  • Bendamustine
  • Bendroflumethiazide; Nadolol
  • Benzhydrocodone; Acetaminophen
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Benztropine
  • Betaxolol
  • Bicalutamide
  • Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
  • Bismuth Subsalicylate
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Bisoprolol; Hydrochlorothiazide, HCTZ
  • Bortezomib
  • Brexpiprazole
  • Brigatinib
  • Brimonidine
  • Brimonidine; Brinzolamide
  • Brimonidine; Timolol
  • Brivaracetam
  • Brompheniramine
  • Brompheniramine; Carbetapentane; Phenylephrine
  • Brompheniramine; Dextromethorphan; Guaifenesin
  • Brompheniramine; Dextromethorphan; Phenylephrine
  • Brompheniramine; Guaifenesin; Hydrocodone
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Brompheniramine; Pseudoephedrine
  • Bupivacaine
  • Bupivacaine Liposomal
  • Bupivacaine; Lidocaine
  • Buprenorphine
  • Buprenorphine; Naloxone
  • Bupropion
  • Bupropion; Naltrexone
  • Buspirone
  • Butorphanol
  • Caffeine
  • Caffeine; Ergotamine
  • Calcifediol
  • Calcitriol
  • Candesartan; Hydrochlorothiazide, HCTZ
  • Cannabidiol
  • Capmatinib
  • Captopril; Hydrochlorothiazide, HCTZ
  • Carbamazepine
  • Carbetapentane; Chlorpheniramine
  • Carbetapentane; Chlorpheniramine; Phenylephrine
  • Carbetapentane; Diphenhydramine; Phenylephrine
  • Carbetapentane; Guaifenesin
  • Carbetapentane; Guaifenesin; Phenylephrine
  • Carbetapentane; Phenylephrine
  • Carbetapentane; Phenylephrine; Pyrilamine
  • Carbetapentane; Pseudoephedrine
  • Carbetapentane; Pyrilamine
  • Carbidopa; Levodopa; Entacapone
  • Carbinoxamine
  • Carbinoxamine; Dextromethorphan; Pseudoephedrine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Carbinoxamine; Phenylephrine
  • Carbinoxamine; Pseudoephedrine
  • Cardiac glycosides
  • Cariprazine
  • Cenobamate
  • Cetirizine
  • Cetirizine; Pseudoephedrine
  • Cevimeline
  • Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
  • Chlorambucil
  • Chloramphenicol
  • Chlordiazepoxide
  • Chlordiazepoxide; Clidinium
  • Chlorothiazide
  • Chlorpheniramine
  • Chlorpheniramine; Codeine
  • Chlorpheniramine; Dextromethorphan
  • Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Phenylephrine
  • Chlorpheniramine; Pseudoephedrine
  • Chlorthalidone
  • Chlorthalidone; Clonidine
  • Choline Salicylate; Magnesium Salicylate
  • Cinacalcet
  • Citalopram
  • Clemastine
  • Clobazam
  • Clonazepam
  • Clorazepate
  • Clozapine
  • Cobimetinib
  • Codeine
  • Codeine; Guaifenesin
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • Colesevelam
  • COMT inhibitors
  • Conjugated Estrogens
  • Conjugated Estrogens; Bazedoxifene
  • Conjugated Estrogens; Medroxyprogesterone
  • Cyclophosphamide
  • Cyclosporine
  • Cyproheptadine
  • Darifenacin
  • Darunavir
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Delavirdine
  • Deutetrabenazine
  • Dexchlorpheniramine
  • Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Dexmedetomidine
  • Dextroamphetamine
  • Dextromethorphan; Diphenhydramine; Phenylephrine
  • Dextromethorphan; Quinidine
  • Diazepam
  • Diclofenac
  • Diclofenac; Misoprostol
  • Dicyclomine
  • Dienogest; Estradiol valerate
  • Diethylstilbestrol, DES
  • Dihydrocodeine; Guaifenesin; Pseudoephedrine
  • Diltiazem
  • Dimenhydrinate
  • Diphenhydramine
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Diphenhydramine; Phenylephrine
  • Disopyramide
  • Dolutegravir; Rilpivirine
  • Donepezil
  • Donepezil; Memantine
  • Doxercalciferol
  • Doxorubicin
  • Doxycycline
  • Doxylamine
  • Doxylamine; Pyridoxine
  • Dronabinol
  • Dronedarone
  • Droperidol
  • Drospirenone; Estradiol
  • Drospirenone; Ethinyl Estradiol
  • Drospirenone; Ethinyl Estradiol; Levomefolate
  • Efavirenz
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elagolix; Estradiol; Norethindrone acetate
  • Elbasvir; Grazoprevir
  • Eltrombopag
  • Empagliflozin; Linagliptin
  • Empagliflozin; Linagliptin; Metformin
  • Emtricitabine; Rilpivirine; Tenofovir alafenamide
  • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
  • Enalapril; Felodipine
  • Enalapril; Hydrochlorothiazide, HCTZ
  • Entacapone
  • Eprosartan; Hydrochlorothiazide, HCTZ
  • Erdafitinib
  • Erlotinib
  • Escitalopram
  • Esketamine
  • Eslicarbazepine
  • Esomeprazole
  • Esomeprazole; Naproxen
  • Estazolam
  • Esterified Estrogens
  • Esterified Estrogens; Methyltestosterone
  • Estradiol
  • Estradiol Cypionate; Medroxyprogesterone
  • Estradiol; Levonorgestrel
  • Estradiol; Norethindrone
  • Estradiol; Norgestimate
  • Estradiol; Progesterone
  • Estrogens
  • Estropipate
  • Eszopiclone
  • Ethanol
  • Ethinyl Estradiol
  • Ethinyl Estradiol; Desogestrel
  • Ethinyl Estradiol; Ethynodiol Diacetate
  • Ethinyl Estradiol; Etonogestrel
  • Ethinyl Estradiol; Levonorgestrel
  • Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
  • Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
  • Ethinyl Estradiol; Norelgestromin
  • Ethinyl Estradiol; Norethindrone
  • Ethinyl Estradiol; Norethindrone Acetate
  • Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
  • Ethinyl Estradiol; Norethindrone; Ferrous fumarate
  • Ethinyl Estradiol; Norgestimate
  • Ethinyl Estradiol; Norgestrel
  • Ethosuximide
  • Ezetimibe; Simvastatin
  • Felodipine
  • Fenfluramine
  • Fenoprofen
  • Fentanyl
  • Flibanserin
  • Fluconazole
  • Fluoxetine; Olanzapine
  • food
  • Fosamprenavir
  • Fosinopril; Hydrochlorothiazide, HCTZ
  • Gabapentin
  • Gallium Ga 68 Dotatate
  • General anesthetics
  • Glasdegib
  • Glimepiride
  • Glimepiride; Pioglitazone
  • Glimepiride; Rosiglitazone
  • Green Tea
  • Griseofulvin
  • Guaifenesin; Hydrocodone
  • Guaifenesin; Hydrocodone; Pseudoephedrine
  • Guanfacine
  • Haloperidol
  • Hemin
  • Homatropine; Hydrocodone
  • Hydantoins
  • Hydralazine; Hydrochlorothiazide, HCTZ
  • Hydrochlorothiazide, HCTZ
  • Hydrochlorothiazide, HCTZ; Irbesartan
  • Hydrochlorothiazide, HCTZ; Lisinopril
  • Hydrochlorothiazide, HCTZ; Losartan
  • Hydrochlorothiazide, HCTZ; Methyldopa
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Moexipril
  • Hydrochlorothiazide, HCTZ; Olmesartan
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Hydrochlorothiazide, HCTZ; Quinapril
  • Hydrochlorothiazide, HCTZ; Spironolactone
  • Hydrochlorothiazide, HCTZ; Telmisartan
  • Hydrochlorothiazide, HCTZ; Triamterene
  • Hydrochlorothiazide, HCTZ; Valsartan
  • Hydrocodone
  • Hydrocodone; Ibuprofen
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Hydromorphone
  • Hydroxychloroquine
  • Hydroxyzine
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Ibuprofen; Oxycodone
  • Iloperidone
  • Imatinib
  • Indinavir
  • Isavuconazonium
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Isradipine
  • Itraconazole
  • Ivabradine
  • Ixabepilone
  • Ketoconazole
  • Lansoprazole
  • Lansoprazole; Naproxen
  • Lasmiditan
  • Lemborexant
  • Lesinurad
  • Lesinurad; Allopurinol
  • Leucovorin
  • Levobupivacaine
  • Levocetirizine
  • Levoleucovorin
  • Levorphanol
  • Linagliptin
  • Linagliptin; Metformin
  • Lisdexamfetamine
  • Lithium
  • Lofexidine
  • Lopinavir; Ritonavir
  • Lorazepam
  • Lorlatinib
  • Lovastatin
  • Lovastatin; Niacin
  • Loxapine
  • Lurasidone
  • Lurbinectedin
  • Magnesium Salicylate
  • Magnesium Salts
  • Mannitol
  • Maprotiline
  • Mebendazole
  • Meclizine
  • Mefloquine
  • Melatonin
  • Meperidine
  • Meperidine; Promethazine
  • Meprobamate
  • Mestranol; Norethindrone
  • Metformin; Repaglinide
  • Methadone
  • Methazolamide
  • Methocarbamol
  • Methscopolamine
  • Methsuximide
  • Methyclothiazide
  • Metoclopramide
  • Metolazone
  • Metronidazole
  • Metyrapone
  • Metyrosine
  • Mexiletine
  • Midazolam
  • Minocycline
  • Mirtazapine
  • Mitotane
  • Modafinil
  • Molindone
  • Monoamine oxidase inhibitors
  • Morphine
  • Morphine; Naltrexone
  • Nabilone
  • Nalbuphine
  • Nanoparticle Albumin-Bound Paclitaxel
  • Nelfinavir
  • Neratinib
  • Nevirapine
  • Niacin; Simvastatin
  • Nicardipine
  • Nifedipine
  • Nimodipine
  • Nintedanib
  • Nisoldipine
  • Olanzapine
  • Olaparib
  • Ombitasvir; Paritaprevir; Ritonavir
  • Omeprazole
  • Omeprazole; Amoxicillin; Rifabutin
  • Omeprazole; Sodium Bicarbonate
  • Ondansetron
  • Oxazepam
  • Oxybutynin
  • Oxycodone
  • Oxymorphone
  • Paclitaxel
  • Paliperidone
  • Papaverine
  • Paroxetine
  • Pemigatinib
  • Pentazocine
  • Pentazocine; Naloxone
  • Perampanel
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  • Simvastatin
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  • Skeletal Muscle Relaxants
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  • Tetrabenazine
  • Thalidomide
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  • Voriconazole
  • Vortioxetine
  • Warfarin
  • Zaleplon
  • Ziconotide
  • Ziprasidone
  • Zolpidem
  • Zonisamide

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