The barbiturates are nonselective central nervous system depressants which are primarily used as sedative hypnotics and also anticonvulsants in subhypnotic doses. The barbiturates and their sodium salts are subject to control under the Federal Controlled Substances Act (See Drug Abuse and Dependence section).
The sodium salts of amobarbital, pentobarbital, phenobarbital, and secobarbital are available as sterile parenteral solutions.
Barbiturates are substituted pyrimidine derivatives in which the basic structure common to these drugs is barbituric acid, a substance which has no central nervous system (CNS) activity. CNS activity is obtained by substituting alkyl, alkenyl, or aryl groups on the pyrimidine ring.
NEMBUTAL Sodium Solution (pentobarbital sodium injection) is a sterile solution for intravenous or intramuscular injection. Each mL contains pentobarbital sodium 50 mg, in a vehicle of propylene glycol, 40%, alcohol, 10% and water for injection, to volume. The pH is adjusted to approximately 9.5 with hydrochloric acid and/or sodium hydroxide.
NEMBUTAL (pentobarbital) is indicated for the following:
- Hypnotics, for the short-term treatment of insomnia, since they appear to lose their effectiveness for sleep induction and sleep maintenance after 2 weeks (See Clinical Pharmacology section.)
- Anticonvulsant, in anesthetic doses, in the emergency control of certain acute convulsive episodes, e.g., those associated with status epilepticus, cholera, eclampsia, meningitis, tetanus, and toxic reactions to strychnine or local anesthetics.
Published Studies Related to Nembutal (Pentobarbital)
Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury: a randomized controlled trial. 
INTRODUCTION: Experimental research has demonstrated that the level of neuroprotection conferred by the various barbiturates is not equal. Until now no controlled studies have been conducted to compare their effectiveness, even though the Brain Trauma Foundation Guidelines recommend that such studies be undertaken. The objectives of the present study were to assess the effectiveness of pentobarbital and thiopental in terms of controlling refractory intracranial hypertension in patients with severe traumatic brain injury, and to evaluate the adverse effects of treatment... CONCLUSIONS: Thiopental appeared to be more effective than pentobarbital in controlling intracranial hypertension refractory to first-tier measures. These findings should be interpreted with caution because of the imbalance in cranial tomography characteristics and the different dosages employed in the two arms of the study. The incidence of adverse effects was similar in both groups. TRIAL REGISTRATION: (Trial registration: US Clinical Trials registry NCT00622570.).
Comparison of propofol with pentobarbital/midazolam/fentanyl sedation for magnetic resonance imaging of the brain in children. [2007.09]
OBJECTIVE: Propofol and pentobarbital, alone or combined with other agents, are frequently used to induce deep sedation in children for MRI. However, we are unaware of a previous comparison of these 2 agents as part of a randomized, controlled trial. We compared the recovery time of children after deep sedation with single-agent propofol with a pentobarbital-based regimen for MRI and considered additional variables of safety and efficacy... CONCLUSIONS: Propofol permits faster onset and recovery than, and comparable efficacy to, a pentobarbital/midazolam/fentanyl regimen for sedation of children for MRI.
Relative abuse liability of GHB in humans: A comparison of psychomotor, subjective, and cognitive effects of supratherapeutic doses of triazolam, pentobarbital, and GHB. [2006.11]
Although preclinical studies suggest that GHB has low likelihood for abuse, case reports indicate that GHB is abused. This study evaluated the relative abuse liability of GHB in 14 volunteers with histories of drug abuse... Although the likelihood for GHB to be abused is intermediate to triazolam and pentobarbital, the possibility of accidental overdose (ie greater sedation than intended) with GHB appears to be greater.
[Comparison of the effectiveness of pentobarbital and thiopental in patients with refractory intracranial hypertension. Preliminary report of 20 patients] [2005.02]
CONCLUSIONS:These preliminary results indicate that thiopental could be more effective than pentobarbital in patients with refractory intracranial hypertension. These results support previous experimental findings that show that both treatments are not equal and justify to continue this study.
Etomidate versus pentobarbital for sedation of children for head and neck CT imaging. [2004.08]
OBJECTIVES: We compare etomidate to pentobarbital for sedation of children for head and neck computed tomography imaging... CONCLUSIONS: At the dosing used in this study, pentobarbital is superior to etomidate when comparing success rates for sedation. However, among the successful sedations, the duration of sedation was shorter in the etomidate group than in the pentobarbital group. Pentobarbital is associated with more frequent side effects and parental concerns compared to etomidate.
Clinical Trials Related to Nembutal (Pentobarbital)
Dexmedetomidine Versus Pentobarbital for Pediatric Procedural Sedation [Withdrawn]
The investigators believe dexmedetomidine will provide superior sedation with reduced side
effects and reduced time to discharge compared with pentobarbital. The investigators have
developed sedation protocols with pentobarbital and dexmedetomidine in our ambulatory
procedure center. These protocols are both routinely used for sedation in our unit. The
investigators propose to study these two protocols in children ages 6 months to 6 years
presenting to the ambulatory procedure center for non-painful procedural sedation. The
investigators will compare failure of sedation, side effect profile, recovery and discharge
times between the two pharmacologic protocols.
Comparison of Effectiveness of Pentobarbital and Thiopental in Patients With Refractory Intracranial Hypertension [Terminated]
Objective: to assess the effectiveness of pentobarbital and thiopental to control raised
intracranial pressure (ICP), refractory to first level measures, in patients with severe
traumatic brain injury.
Material and methods: prospective, randomized open study to compare the effectiveness
between two treatments: pentobarbital and thiopental. The patients will be selected from
those admitted to the Intensive Care Unit with a severe traumatic brain injury
(postresuscitation Glasgow Coma Scale equal or less than 8 points) and raised ICP (ICP>20
mmHg) refractory to first level measures according to the Brain Trauma Foundation
guidelines. The adverse effects of both treatments were also collected.
A Comparison of Two Sedation Techniques in Children Undergoing Transthoracic Echocardiography (TTE) [Recruiting]
The study will examine the quality of two sedation techniques (dexmedetomidine and
pentobarbital) used for children aged 3 to 24 months who are undergoing a transthoracic
Sedation for Brainstem Evoked Auditory Response (BEAR) Testing Using Intravenous Pentobarbital [Completed]
This is a retrospective chart review study (700 charts from 2002 to 2010)of children from 0
to 18 years of age who have undergone Brainstem Evoked Auditory Response (BEAR)testing using
midazolam and pentobarbital protocol for moderate sedation. The specific aims of this study
1. to determine the efficacy of intravenous pentobarbital during BEAR testing in the
pediatric population using a standardized protocol; and
2. to evaluate the incidence of adverse events (major and minor), paradoxical reaction and
failed sedation and identify predictors for failure and adverse events if any.
GHB Withdrawal Symptoms and Effectiveness of Treatment With Lorazepam Versus Pentobarbital - 1 [Terminated]
Gamma hydroxybutyrate (GHB) is a powerful central nervous system depressant. The number of
individuals seeking treatment for GHB abuse has been steadily increasing in the United
States. Currently, lorazepam and pentobarbital are two medications used to treat
individuals who experience GHB-withdrawal symptoms. The purpose of this study is to
describe the signs and symptoms of GHB withdrawal and to identify predictors of withdrawal
severity. The study will also evaluate the safety and effectiveness of treatment with
lorazepam versus pentobarbital for GHB detoxification.
Page last updated: 2008-11-03