Pentobarbital

Pentobarbital is a short acting barbiturate that is available as both a free acid and a sodium salt, the former of which is only slightly soluble in water and ethanol. One trade name for this drug is Nembutal®.

Uses

Approved

Pentobarbital's FDA approved human uses include treatment of seizures and preoperative (and other) sedation; it is also approved as a short-term hypnotic.

In France, it is used in the treatment of insomnia, and as a pre-anaesthetic.

Unapproved/Investigational/Off-Label

Off-label uses of pentobarbital include reduction of intracranial pressure in Reye's syndrome, traumatic brain injury and induction of coma in cerebral ischaemia patients.

Human Euthanasia

Pentobarbital has also been used for physician-assisted suicide. Pentobarbital was used in the Northern Territory of Australia, prior to euthanasia becoming illegal.

Metabolism

Pentobarbital undergoes first-pass metabolism in the liver and possibly the intestines.

Drug Interactions

Administration of alcohol, opioids, antihistamines, other sedative-hypnotics, and other central nervous system depressants will additively increase the sedation caused by pentobarbital.

The S-isomers of fluoxetine and its active metabolite, norfluoxetine, reverse the down-regulation of allopregnanolone by pentobarbital, thus reversing the loss of righting reflex, at doses 10-50 times lower than that required for serotonin reuptake.

Tricyclic antidepressants decrease serum levels of pentobarbital.

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