Pentobarbital

Administration

• Type: Anticonvulsant, Barbiturate
• Routes of Administration: IV, IM
• Common Trade Names: Nembutal

Adult Dosing

• Procedural sedation: 150-200mg IM x1
  • Onset 10-15min IM; duration 1-4h IM

• Barbiturate coma: 1-3mg/kg/h IV
  • Start: 10-15mg/kg IV x1, then 1mg/kg/h IV
  • Taper dose gradually to discontinue if long-term use

Pediatric Dosing

• Procedural sedation: 2-6mg/kg IM x1
  • Max: 100mg/dose
  • Onset: 10-15min IM, 1min IV; duration: 1-4h IM, 15min IV

• Barbiturate coma: 1-3mg/kg/h IV
  • Start: 10-15mg/kg IV x1, then 1mg/kg/h IV
  • Taper dose gradually to discontinue if long-term use

Special Populations

• Pregnancy Rating: D

Renal Dosing

• Renal impairment: decrease start dose

Hepatic Dosing

• Hepatic impairment: decrease start dose

Contraindications

• Allergy to class/drug
• Depressed respiratory function
• Porphyria
• Avoid abrupt withdrawal (long-term use)

Adverse Reactions

Serious

• respiratory depression
• Stevens-Johnson syndrome
• angioedema
• lupus erythematosus

Common

• somnolence
• agitation
• confusion
• hyperkinesia
• ataxia
• CNS depression

Pharmacology

• Half-life: 15-50 hrs
• Metabolism: CYP450
• Excretion: Urine

Mechanism of Action

alters sensory cortex, cerebellar, and motor activities; produces sedation, hypnosis, and anesthesia

Indications by Condition

The following table is automatically generated from disease/condition pages across WikEM.

Indication	Dose	Context	Route	Population
Elevated intracranial pressure	10 mg/kg IV over 30 min, then 5 mg/kg/hr x3 hrs, then 1 mg/kg/hr	Barbiturate coma for refractory ICP	IV	Adult
Moderate-to-severe traumatic brain injury	10 mg/kg IV over 30 min, then 5 mg/kg/hr x3 hrs, then 1 mg/kg/hr	Barbiturate coma for refractory ICP	IV	Adult
Traumatic intracerebral hemorrhage	10 mg/kg IV over 30 min, then 5 mg/kg/hr x3 hrs, then 1 mg/kg/hr	Barbiturate coma for refractory ICP	IV	Adult

See Also

• Seizure
• Anticonvulsants
• Anticonvulsant levels and reloading