BARBITURATES (Systemic)
Some commonly used brand names are:
In the U.S.?
- Alurate 2
- Amytal 1
- Barbita 7
- Busodium 3
- Butalan 3
- Butisol 3
- Luminal 7
- Mebaral 4
- Nembutal 6
- Sarisol No. 2 3
- Seconal 8
- Solfoton 7
- Tuinal 9
In Canada?
- Amytal 1
- Ancalixir 7
- Butisol 3
- Mebaral 4
- Nembutal 6
- Nova Rectal 6
- Novopentobarb 6
- Novosecobarb 8
- Seconal 8
- Tuinal 9
Gemonil 5Note: | For quick reference, the following barbiturates are numbered to matchthe corresponding brand names. |
Category
- Anticonvulsant?Amobarbital (parenteral only); Mephobarbital; Metharbital; Pentobarbital (parenteral only); Phenobarbital; Secobarbital (parenteralonly)
- Antihyperbilirubinemic?Phenobarbital
- Sedative-hypnotic?Amobarbital; Aprobarbital; Butabarbital; Pentobarbital; Phenobarbital(parenteral only); Secobarbital
Description
Barbiturates (bar-BI-tyoo-rates)belong to the groupof medicines called central nervous system (CNS) depressants (medicines thatcause drowsiness). They act on the brain and CNS to produce effects that maybe helpful or harmful. This depends on the individual patient's conditionand response and the amount of medicine taken.
Some of the barbiturates may be used before surgery to relieve anxietyor tension. In addition, some of the barbiturates are used as anticonvulsantsto help control seizures in certain disorders or diseases, such as epilepsy.Barbiturates may also be used for other conditions as determined by your doctor.
The barbiturates have been used to treat insomnia (trouble in sleeping);but if they are used regularly (for example, every day) for insomnia, theyare usually not effective for longer than 2 weeks. The barbiturates have alsobeen used to relieve nervousness or restlessness during the daytime. However,the barbiturates have generally been replaced by safer medicines for the treatmentof insomnia and daytime nervousness or tension.
If too much of a barbiturate is used, it may become habit-forming.
Barbiturates should not be used for anxiety or tension caused by the stressof everyday life.
These medicines are available only with your doctor's prescription, inthe following dosage forms:
Oral- Amobarbital
- Capsules (U.S. and Canada)
- Tablets (U.S. and Canada)
- Aprobarbital
- Butabarbital
- Capsules (U.S.)
- Elixir (U.S.)
- Tablets (U.S. and Canada)
- Mephobarbital
- Tablets (U.S. and Canada)
- Metharbital
- Tablets (Other countries)
- Pentobarbital
- Capsules (U.S. and Canada)
- Elixir (U.S.)
- Phenobarbital
- Capsules (U.S.)
- Elixir (U.S. and Canada)
- Tablets (U.S. and Canada)
- Secobarbital
- Capsules (U.S. and Canada)
- Secobarbital and Amobarbital
- Capsules (U.S. and Canada)
Parenteral- Amobarbital
- Injection (U.S. and Canada)
- Pentobarbital
- Injection (U.S. and Canada)
- Phenobarbital
- Injection (U.S. and Canada)
- Secobarbital
Rectal- Pentobarbital
- Suppositories (U.S. and Canada)
Before Using This Medicine
In deciding to use a medicine,the risks of taking the medicine must be weighed against the good it willdo. This is a decision you and your doctor will make. For barbiturates, thefollowing should be considered:
Allergies?Tell your doctor if you have ever had any unusual orallergic reaction to barbiturates. Also tell your health care professionalif you are allergic to any other substances, such as foods, preservatives,or dyes.
Pregnancy?Barbiturates have been shown to increase the chanceof birth defects in humans. However, this medicine may be needed in seriousdiseases or other situations that threaten the mother's life. Be sure youhave discussed this and the following information with your doctor:
- Taking barbiturates regularly during pregnancy may cause bleedingproblems in the newborn infant. In addition, taking barbiturates regularlyduring the last 3 months of pregnancy may cause the baby to become dependenton the medicine. This may lead to withdrawal side effects in the baby afterbirth.
- One study in humans has suggested that barbiturates taken duringpregnancy may increase the chance of brain tumors in the baby.
- Barbiturates taken for anesthesia during labor and delivery may reducethe force and frequency of contractions of the uterus; this may prolong laborand delay delivery.
- Use of barbiturates during labor may cause breathing problems inthe newborn infant.
Breast-feeding?Barbiturates pass into the breast milk and maycause drowsiness, slow heartbeat, shortness of breath, or troubled breathingin babies of nursing mothers taking this medicine.
Children?Unusual excitement may be more likely to occur inchildren, who are usually more sensitive than adults to the effects of barbiturates.
Older adults?Confusion, mental depression, and unusual excitementmay be more likely to occur in the elderly, who are usually more sensitivethan younger adults to the effects of barbiturates.
Other medicines?Although certain medicines should not be usedtogether at all, in other cases 2 different medicines may be used togethereven if an interaction might occur. In these cases, your doctor may want tochange the dose, or other precautions may be necessary. When you are takinga barbiturate, it is especially important that your health care professionalknow if you are taking any of the following:
- Adrenocorticoids (cortisone-like medicine) or
- Anticoagulants (blood thinners) or
- Carbamazepine or
- Corticotropin (ACTH)?Barbiturates may decrease the effectsof these medicines
- Central nervous system (CNS) depressants (medicines that cause drowsiness)?Usingthese medicines with barbiturates may result in increased CNS depressant effects
- Divalproex sodium or
- Valproic acid?Using these medicines with barbiturates may changethe amount of either medicine that you need to take
- Oral contraceptives (birth control pills) containing estrogens?Barbituratesmay decrease the effectiveness of these oral contraceptives, and you may needto change to a different type of birth control
Other medical problems?The presence of other medicalproblems may affect the use of barbiturates. Make sure you tell your doctorif you have any other medical problems, especially:
- Alcohol abuse (or history of) or
- Drug abuse or dependence (or history of)?Dependence on barbituratesmay develop
- Anemia (severe) or
- Asthma (history of), emphysema, or other chronic lung disease or
- Type 2 diabetes mellitus or
- Hyperactivity (in children) or
- Mental depression or
- Overactive thyroid or
- Porphyria (or history of)?Barbiturates may make the conditionworse
- Kidney disease or
- Liver disease?Higher blood levels of barbiturates may result,increasing the chance of side effects
- Pain?Barbiturates may cause unexpected excitement or mask importantsymptoms of more serious problems
- Underactive adrenal gland?Barbiturates may interfere with theeffects of other medicines needed for this condition
Proper Use of This Medicine
For patientstaking the extended-release capsule or tablet formof this medicine:
- These capsules or tablets are to be swallowed whole. Do not break,crush, or chew before swallowing.
For patients using the rectal suppository formof this medicine:
- To insert the suppository: First remove the foil wrapper and moistenthe suppository with cold water. Lie down on your side and use your fingerto push the suppository well up into the rectum.
- Wash your hands with soap and water.
Use this medicine only as directed by your doctor.Do not use more of it, do not use it more often, and do not use it for a longertime than your doctor ordered. If too much is used, it may become habit-forming(causing mental or physical dependence).
If you think this medicine is not working properly after you have takenit for a few weeks, do not increase the dose.To do so may increase the chance of your becoming dependent on the medicine.Instead, check with your doctor.
If you are taking this medicine for epilepsy, it mustbe taken every day in regularly spaced doses as ordered by your doctor inorder for it to control your seizures. This is necessary to keep aconstant amount of medicine in the blood. To help keep the amount constant,do not miss any doses.
Dosing?The dose of barbiturates will be differentfor different patients. Follow your doctor's orders orthe directions on the label. The following information includes onlythe average doses of barbiturates. If your dose is different,do not change it unless your doctor tells you to do so.
The number of capsules, tablets, or teaspoonfuls of elixir that you take,the number of suppositories you use, or the number of injections you receivedepends on the strength of the medicine. Also, the numberof doses you take each day, the time allowed between doses, and the lengthof time you take the medicine depend on the medical problem for which youare taking barbiturates.
For amobarbital- For oral dosage form (tablets or capsules):
- For trouble in sleeping:
- Adults?65 to 200 milligrams (mg) at bedtime.
- Children?Dose must be determined by your doctor.
- For daytime sedation:
- Adults?50 to 300 mg, taken in smaller doses during the day.
- Children?Dose is based on body weight or size and must be determinedby your doctor. The usual dose is 2 mg per kilogram (kg) (0.9 mg per pound)of body weight taken three times a day.
- For sedation before surgery:
- Adults?200 mg taken one to two hours before surgery.
- Children?Dose is based on body weight and must be determinedby your doctor. The usual dose is 2 to 6 mg per kg (0.9 to 2.7 mg per pound)of body weight, taken before surgery. However, the dose is usually not morethan 100 mg.
- For sedation during labor:
- Adults?200 to 400 mg every one to three hours if needed. However,the total dose is usually not more than 1000 mg.
- For injection dosage form:
- For trouble in sleeping:
- Adults?65 to 200 mg, injected into a muscle or vein.
- Children up to 6 years of age?Dose is based on body weightand must be determined by your doctor. The usual dose is 2 to 3 mg per kg(0.9 to 1.4 mg per pound) of body weight, injected into a muscle.
- Children 6 years of age and over?Dose is based on body weightand must be determined by your doctor. The usual dose is 2 to 3 mg per kg(0.9 to 1.4 mg per pound) of body weight, injected into a muscle, or 65 to500 mg injected into a vein.
- For daytime sedation:
- Adults?30 to 50 mg two or three times a day, injected intoa muscle or vein.
- For sedation before surgery:
- Children?Dose is based on body weight and must be determinedby your doctor. The usual dose is 3 to 5 mg per kg (1.4 to 2.3 mg per pound)of body weight or 65 to 500 mg per dose, injected into a vein.
- For control of seizures:
- Adults and children 6 years of age and over?65 to 500 mg perdose, injected into a vein.
- Children up to 6 years of age?Dose is based on body weightor size and must be determined by your doctor. The usual dose is 3 to 5 mgper kg (1.4 to 2.3 mg per pound) of body weight, injected into a muscle orvein.
For aprobarbital- For oral dosage form (elixir):
- For trouble in sleeping:
- Adults?40 to 160 milligrams (mg) at bedtime.
- Children?Dose must be determined by your doctor.
- For daytime sedation:
- Adults?40 mg three times a day.
- Children?Dose must be determined by your doctor.
For butabarbital- For oral dosage form (elixir or tablets):
- For trouble in sleeping:
- Adults?50 to 100 milligrams (mg) at bedtime.
- Children?Dose must be determined by your doctor.
- For daytime sedation:
- Adults?15 to 30 mg three or four times a day.
- Children?Dose is based on body weight or size and must be determinedby your doctor. The usual dose is 2 mg per kilogram (kg) (0.9 mg per pound)of body weight three times a day.
- For sedation before surgery:
- Adults?50 to 100 mg sixty to ninety minutes before surgery.
- Children?Dose is based on body weight and must be determinedby your doctor. The usual dose is 2 to 6 mg per kg (0.9 to 2.7 mg per pound)of body weight. However, the dose is usually not more than 100 mg.
For mephobarbital- For oral dosage form (tablets):
- For daytime sedation:
- Adults?32 to 100 milligrams (mg) three or four times a day.
- Children?16 to 32 mg three or four times a day.
- For control of seizures:
- Adults?200 to 600 mg a day, taken in smaller doses during theday.
- Children up to 5 years of age?16 to 32 mg three or four timesa day.
- Children 5 years of age and over?32 to 64 mg three or fourtimes a day.
For metharbital- For oral dosage form (tablets):
- For control of seizures:
- Adults?At first, 100 milligrams (mg) one to three times a day.Your doctor may increase your dose if needed. However, the dose is usuallynot more than 800 mg a day.
- Children?50 mg one to three times a day.
For pentobarbital- For oral dosage form (elixir or capsules):
- For trouble in sleeping:
- Adults?100 milligrams (mg) at bedtime.
- Children?Dose must be determined by your doctor.
- For daytime sedation:
- Adults?20 mg three or four times a day.
- Children?Dose is based on body weight and must be determinedby your doctor. The usual dose is 2 to 6 mg per kilogram (kg) (0.9 to 2.7mg per pound) of body weight per day.
- For sedation before surgery:
- Adults?100 mg before surgery.
- Children?Dose is based on body weight and must be determinedby your doctor. The usual dose is 2 to 6 mg per kilogram (0.9 to 2.7 mg perpound) of body weight, taken before surgery. However, the dose is usuallynot more than 100 mg.
- For injection dosage form:
- For trouble in sleeping:
- Adults?150 to 200 mg, injected into a muscle. Or, 100 mg injectedinto a vein, with additional small doses given if needed. However, the doseis usually not more than 500 mg.
- Children?Dose is based on body weight and must be determinedby your doctor. The usual dose is 2 to 6 mg per kg (0.9 to 2.7 mg per pound)of body weight, injected into a muscle. Or, 50 mg injected into a vein, withadditional small doses given if needed.
- For sedation before surgery:
- Adults?150 to 200 mg, injected into a muscle.
- Children?Dose is based on body weight and must be determinedby your doctor. The usual dose is 2 to 6 mg per kg (0.9 to 2.7 mg per pound)of body weight, injected into a muscle. However, the dose is usually not morethan 100 mg.
- For control of seizures:
- Adults?At first, 100 mg injected into a vein. Additional smalldoses may be given if needed. However, the dose is usually not more than 500mg.
- Children?At first, 50 mg injected into a muscle or vein. Additionalsmall doses may be given if needed.
- For rectal dosage form (suppositories):
- For trouble in sleeping:
- Adults?120 to 200 mg inserted into the rectum at bedtime.
- Children up to 2 months of age?Dose must be determined by yourdoctor.
- Children 2 months to 1 year of age?30 mg inserted into therectum at bedtime.
- Children 1 to 4 years of age?30 or 60 mg inserted into therectum at bedtime.
- Children 5 to 12 years of age?60 mg inserted into the rectumat bedtime.
- Children 12 to 14 years of age?60 or 120 mg inserted into therectum at bedtime.
- For daytime sedation:
- Adults?30 mg inserted into the rectum two to four times a day.
- Children?Dose is based on body weight or size and must be determinedby your doctor. The usual dose is 2 mg per kg (0.9 mg per pound) of body weight,inserted into the rectum three times a day.
- For sedation before surgery:
- Children up to 2 months of age?Dose must be determined by yourdoctor.
- Children 2 months to 1 year of age?30 mg inserted into therectum.
- Children 1 to 4 years of age?30 or 60 mg inserted into therectum.
- Children 5 to 12 years of age?60 mg inserted into the rectum.
- Children 12 to 14 years of age?60 or 120 mg inserted into therectum.
For phenobarbital- For oral dosage form (elixir, capsules,or tablets):
- For trouble in sleeping:
- Adults?100 to 320 milligrams (mg) at bedtime.
- Children?Dose must be determined by your doctor.
- For daytime sedation:
- Adults?30 to 120 mg a day, taken in smaller doses two or threetimes during the day.
- Children?Dose is based on body weight or size and must be determinedby your doctor. The usual dose is 2 mg per kilogram (kg) (0.9 mg per pound)of body weight three times a day.
- For sedation before surgery:
- Children?Dose is based on body weight and must be determinedby your doctor. The usual dose is 1 to 3 mg per kg (0.45 to 1.4 mg per pound)of body weight.
- For control of seizures:
- Adults?60 to 250 mg a day.
- Children?Dose is based on body weight and must be determinedby your doctor. The usual dose is 1 to 6 mg per kg (0.45 to 2.7 mg per pound)of body weight a day.
- For injection dosage form:
- For trouble in sleeping:
- Adults?100 to 325 mg, injected into a muscle or vein, or underthe skin.
- Children?Dose must be determined by your doctor.
- For daytime sedation:
- Adults?30 to 120 mg a day, injected into a muscle or a vein,or under the skin, in smaller doses two or three times during the day,
- Children?Dose must be determined by your doctor.
- For sedation before surgery:
- Adults?130 to 200 mg, injected into a muscle sixty to ninetyminutes before surgery.
- Children?Dose is based on body weight and must be determinedby your doctor. The usual dose is 1 to 3 mg per kg (0.45 to 1.4 mg per pound)of body weight, injected into a muscle or vein sixty to ninety minutes beforesurgery.
- For control of seizures:
- Adults?100 to 320 mg injected into a vein. The dose may berepeated if needed, but is usually not more than 600 mg a day. However, higherdoses may be needed for certain types of continuing seizures.
- Children?Dose is based on body weight and must be determinedby your doctor. At first, the usual dose is 10 to 20 mg per kg (4.5 to 9 mgper pound) of body weight, injected into a vein. Later, 1 to 6 mg per kg (0.45to 2.7 mg per pound) of body weight a day, injected into a vein. Higher dosesmay be needed for certain types of continuing seizures.
For secobarbital- For oral dosage form (capsules):
- For trouble in sleeping:
- Adults?100 milligrams (mg) at bedtime.
- Children?Dose must be determined by your doctor.
- For daytime sedation:
- Adults?30 to 50 mg three or four times a day.
- Children?Dose is based on body weight or size and must be determinedby your doctor. The usual dose is 2 mg per kilogram (kg) (0.9 mg per pound)of body weight three times a day.
- For sedation before surgery:
- Adults?200 to 300 mg one or two hours before surgery.
- Children?Dose is based on body weight and must be determinedby your doctor. The usual dose is 2 to 6 mg per kg (0.9 to 2.7 mg per pound)of body weight one or two hours before surgery. However, the dose is usuallynot more than 100 mg.
- For injection dosage form:
- For trouble in sleeping:
- Adults?100 to 200 mg injected into a muscle, or 50 to 250 mginjected into a vein.
- Children?Dose is based on body weight or size and must be determinedby your doctor. The usual dose is 3 to 5 mg per kg (1.4 to 2.3 mg per pound)of body weight, injected into a muscle. However, the dose is usually not morethan 100 mg.
- For sedation before dental procedures:
- Adults?Dose is based on body weight and must be determinedby your doctor. The usual dose is 1.1 to 2.2 mg per kg (0.5 to 1 mg per pound)of body weight, injected into a muscle ten to fifteen minutes before the procedure.
- Children?Dose must be determined by your dentist.
- For sedation before a nerve block:
- Adults?100 to 150 mg, injected into a vein.
- For sedation before surgery:
- Children?Dose is based on body weight and must be determinedby your doctor. The usual dose is 4 to 5 mg per kg (1.8 to 2.3 mg per pound)of body weight, injected into a muscle.
- For seizures from tetanus:
- Adults?Dose is based on body weight and must be determinedby your doctor. The usual dose is 5.5 mg per kg (2.5 mg per pound) of bodyweight, injected into a muscle or vein. Dose may be repeated every three tofour hours if needed.
- Children?Dose is based on body weight and must be determinedby your doctor. The usual dose is 3 to 5 mg per kg (1.4 to 2.3 mg per pound)of body weight, injected into a muscle or vein.
For secobarbital and amobarbital combination- For oral dosage form (capsules):
- For trouble in sleeping:
- Adults?1 capsule at bedtime.
- Children?Dose must be determined by your doctor.
- For sedation before surgery:
- Adults?1 capsule taken one hour before surgery.
- Children?Dose must be determined by your doctor.
Missed dose?If you are taking this medicine regularly (forexample, every day as in epilepsy) and you do miss a dose, take it as soonas possible. However, if it is almost time for your next dose, skip the misseddose and go back to your regular dosing schedule. Do not double doses.
Storage?To store this medicine:
- Keep out of the reach of children since overdose is especially dangerousin children.
- Store away from heat and direct light.
- Do not store the capsule or tablet form of this medicine in the bathroom,near the kitchen sink, or in other damp places. Heat or moisture may causethe medicine to break down.
- Keep the liquid form of this medicine from freezing.
- Store the suppository form of this medicine in the refrigerator.
- Do not keep outdated medicine or medicine no longer needed. Be surethat any discarded medicine is out of the reach of children.
Precautions While Using This Medicine
If youwill be using this medicine regularly for a long time:
- Your doctor should check your progress at regular visits.
- Do not stop using it without first checking with your doctor. Yourdoctor may want you to reduce gradually the amount you are using before stoppingcompletely.
This medicine will add to the effects of alcohol and other CNS depressants(medicines that slow down the nervous system, possibly causing drowsiness).Some examples of CNS depressants are antihistamines or medicine for hay fever,other allergies, or colds; sedatives, tranquilizers, or sleeping medicine;prescription pain medicine or narcotics; medicine for seizures; muscle relaxants;or anesthetics, including some dental anesthetics. Checkwith your doctor before taking any of the above while you are using this medicine.
Before you have any medical tests, tell the medical doctor in charge thatyou are taking this medicine. The results of the metyrapone test may be affectedby this medicine.
If you have been using this medicine for a long timeand you think that you may have become mentally or physically dependent onit, check with your doctor. Some signs of mental or physical dependenceon barbiturates are:
- a strong desire or need to continue taking the medicine.
- a need to increase the dose to receive the effects of the medicine.
- withdrawal side effects (for example, anxiety or restlessness, convulsions[seizures], feeling faint, nausea or vomiting, trembling of hands, troublein sleeping) occurring after the medicine is stopped.
If you think you or someone else may have taken anoverdose of this medicine, get emergency help at once. Taking an overdoseof a barbiturate or taking alcohol or other CNS depressants with the barbituratemay lead to unconsciousness and possibly death. Some signs of an overdoseare severe drowsiness, severe confusion, severe weakness, shortness of breathor slow or troubled breathing, slurred speech, staggering, and slow heartbeat.
This medicine may cause some people to become dizzy, lightheaded, drowsy,or less alert than they are normally. Even if taken at bedtime, it may causesome people to feel drowsy or less alert on arising. Make sure you know how you react to this medicine before you drive, use machines,or do anything else that could be dangerous if you are dizzy or are not alert.
Oral contraceptives (birth control pills) containingestrogen may not work properly if you take them while you are taking barbiturates.Unplanned pregnancies may occur. You should use a different or additionalmeans of birth control while you are taking barbiturates. If you haveany questions about this, check with your health care professional.
Side Effects of This Medicine
Along with its needed effects,a medicine may cause some unwanted effects. Although not all of these sideeffects may occur, if they do occur they may need medical attention.
Check with your doctorimmediately if any of the following side effects occur:
Rare
Bleeding sores on lips; chest pain; fever; muscle or joint pain; red, thickened, or scaly skin; skinrash or hives; sores, ulcers, or white spots in mouth(painful); sore throat and/or fever; swelling of eyelids, face, or lips; wheezing or tightness in chest
Also, check with your doctor as soon as possibleif any of the following side effects occur:
With long-term or chronic use
Bone pain, tenderness, or aching; lossof appetite; muscle weakness; weight loss (unusual); yellow eyes or skin
Other side effects may occur that usually do not need medicalattention. These side effects may go away during treatment as your body adjuststo the medicine. However, check with your doctor if any of the following sideeffects continue or are bothersome:
For veryill patients:
- Confusion, mental depression, and unusual excitement may be morelikely to occur in very ill patients
After you stop using thismedicine, your body may need time to adjust. If you took this medicine inhigh doses or for a long time, this may take up to about 15 days. During thisperiod of time check with your doctor if any of the following side effectsoccur (usually occur within 8 to 16 hours after medicine is stopped):
Anxiety or restlessness; convulsions(seizures); dizziness or lightheadedness; feeling faint; hallucinations (seeing,hearing, or feeling things that are not there); muscle twitching; nausea or vomiting; trembling of hands; trouble in sleeping,increased dreaming, or nightmares; vision problems; weakness
Otherside effects not listed above may also occur in some patients. If you noticeany other effects, check with your doctor.
Additional Information
Once a medicine has been approvedfor marketing for a certain use, experience may show that it is also usefulfor other medical problems. Although this use is not included in product labeling,phenobarbital is used in certain patients with the following medical condition:
- Hyperbilirubinemia (high amount of bile pigments in the blood thatmay lead to jaundice)
Other than the above information, there is no additional information relatingto proper use, precautions, or side effects for these uses.
Revised: 08/15/1995