Pentobarbital
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| Routes of administration | Oral, Intravenous, Intramuscular, Rectal; also Intraperitoneal & Intracardiac (for animal euthanasia) |
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| Pharmacokinetic data | |
| Bioavailability | 70-90% oral; 90% rectal |
| Protein binding | 20-45% |
| Metabolism | Hepatic |
| Elimination half-life | 15-48 hours |
| Excretion | Renal |
| Identifiers | |
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| CompTox Dashboard (EPA) | |
| ECHA InfoCard | 100.000.895 |
| Chemical and physical data | |
| Formula | C11H18N2O3 |
| Molar mass | 226.27 g·mol−1 |
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Pentobarbital is a short-acting barbiturate that was first synthesized in 1928. Pentobarbital is available as both a free acid and a sodium salt, the former of which is only slightly soluble in water and ethanol.[1] One trade name for this drug is Nembutal, coined by Dr. John S. Lundy, who started using it in 1930, from the structural formula of the sodium salt—Na (sodium) + ethyl + methyl + butyl + al (common suffix for barbiturates).[2]
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.[3]
In France and the Netherlands, it is no longer used in the treatment of insomnia, nor as a preanesthetic.[4]
Unapproved/Investigational/Off-Label
Off-label uses of pentobarbital include reduction of intracranial pressure in Reye's syndrome, traumatic brain injury[1] and induction of coma in cerebral ischemia patients.[3] Pentobarbital-induced coma has been advocated in patients with acute liver failure refractory to mannitol.[5]
Veterinary medicine
In veterinary medicine, sodium pentobarbital—traded under names such as Sagatal or "Nembutal" —is used as an anaesthetic.[6] Pentobarbital is an ingredient in Equithesin.
Veterinary euthanasia
It is used by itself, or more often in combination with complementary agents such as phenytoin, in commercial animal euthanasia[7] injectable solutions. Trade names include Euthasol, Euthatal, Euthanal, Euthanyl (in Canada), Beuthanasia-D, Lethabarb, and Fatal Plus.
Human euthanasia
Pentobarbital has also been used for physician-assisted suicide. It is commonly used in the US state of Oregon for this purpose.[8], and is also used by the Swiss euthanasia group Dignitas. Pentobarbital was also used for this purpose in the Northern Territory of Australia, prior to euthanasia becoming illegal in that region.
In the Netherlands, a pentobarbital elixir is used for physician-assisted suicide (an alternative to euthanasia for patients who wish to take the barbiturate needed for the lethal cocktail themselves, instead of having it administered intravenously, in which case thiopental is used). Pentobarbital has no medical use anymore in the Netherlands, and is only used for this purpose.
Typically, when orally ingested for euthanasia purposes, an antiemetic drug is swallowed approximately 30 minutes before the lethal overdose of pentobarbital. This is done because large concentrated doses of pentobarbital may cause vomiting.
In this role, Pentobarbital is highly sought after by people wishing to end their lives but not allowed to do so under their country's laws. It is therefore often smuggled across borders from countries where it is still available over-the-counter such as Mexico, or purchased through illegal mail orders[9]. It has been described as one of the most peaceful ways to commit suicide.
Death penalty
Sodium pentobarbital is also used for executions by lethal injection in China.
Metabolism
Pentobarbital undergoes first-pass metabolism in the liver and possibly the intestines.[10]
Drug interactions
Administration of alcohol, opioids, antihistamines, other sedative-hypnotics, and other central nervous system depressants will greatly increase the sedation effects and risk of accidental death caused by pentobarbital.[3]
Recreational use
Pentobarbital is a drug that has been used recreationally under the slang term "yellow-jacket." Two types of drug use can occur: recreational use, where the drug is taken to achieve a high, or when the drug is continued long term against medical advice.[11]
References in popular culture
The Coroners report of Marilyn Monroe's death concluded her death was due to a massive overdose of 47 Nembutal capsules.
An official autopsy on Jim Jones, famed leader of the cult murder/suicide of over 900 people in Guyana, found very large quantities of Pentobarbital in his system. He probably died by gunshot however.[12]
In the 1957 novel On the Beach by Nevil Shute, the Australian government mass-distributes Nembutal in red cartons for voluntary euthanasia as radiation sickness spreads south in the final days of mankind following World War III.[13]
Pentobarbital is referred to in William S. Burroughs's novel Junky as "Nembutal" "Nembies" and "Goofballs". In the novel it is used to help through heroin withdrawal.
In the HBO show The Sopranos, season 2 episode 12, Janice Soprano uses two Nembutal to sedate her mother, Livia Soprano.
In the HBO show The Wire, season 2 episode 10, Ziggy Sobotka references his mother's apparent abuse of Nembutal to "sleep the day away".
References
- ^ a b "Pentobarbital". San Diego Reference Laboratory: Technical Help. Retrieved 16 July 2005.
{{cite web}}: Unknown parameter|dateformat=ignored (help) - ^ Lee C. Fosburgh (1997). "Imagining in Time: From this point in time: Some memories of my part in the history of anesthesia -- John S. Lundy, MD" ([dead link]). American Association of Nurse Anesthetists Journal. 65 (4): 323–8. PMID 9281913.
- ^ a b c Deglin, Judith Hopfer (2004-06-01) [1988]. Davis's Drug Guide for Nurses (9th ed.). F. A. Davis Company. p. 789. ISBN 978-0-8036-1154-2. Retrieved 2005-07-16.
{{cite book}}: Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ VIDAL (2001). "PENTOBARBITAL SODIQUE". Banque de Données Automatisée sur les Médicaments. Retrieved May 2, 2006.
{{cite web}}: Unknown parameter|dateformat=ignored (help) - ^ Stravitz; Kramer, AH; Davern, T; Shaikh, AO; Caldwell, SH; Mehta, RL; Blei, AT; Fontana, RJ; McGuire, BM; et al. (2007). "Intensive care of patients with acute liver failure:recommendations of the U.S.acute liver failure study group". Crit.Care Med. 35 (11): 2498–2508. doi:10.1097/01.CCM.0000287592.94554.5F. PMID 17901832.
{{cite journal}}: Explicit use of et al. in:|author=(help) - ^ UBC Committee on Animal Care (2005). "Euthanasia". SOP 009E1 - euthanasia - overdose with pentobarbital. The University of British Columbia. Retrieved 4 October 2005.
{{cite web}}: Unknown parameter|dateformat=ignored (help) - ^ Unknown (2003). "ANESTHESIA AND ANALGESIA". Animal Use Protocols. University of Virginia. Retrieved 4 October 2005.
{{cite web}}: Unknown parameter|dateformat=ignored (help) - ^ Goodenough, Patrick (2002-03-26). "Campaigners Rally Round Right-To-Die Woman". CNSNews.com. Retrieved July 22, 2006.
{{cite web}}: Unknown parameter|dateformat=ignored (help) - ^ "Suicide drug of choice in mail", The Australian, March 14, 2009
- ^ Knodell, R. G. (1980). "Alterations in pentobarbital pharmacokinetics in response to parenteral and enteral alimentation in the rat". Gastroenterology. 79 (6): 1211–6. PMID 6777235.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help); Unknown parameter|month=ignored (help) - ^ Griffiths RR, Johnson MW (2005). "Relative abuse liability of hypnotic drugs: a conceptual framework and algorithm for differentiating among compounds". J Clin Psychiatry. 66 Suppl 9: 31–41. PMID 16336040.
- ^ ^ Autopsy of Jim Jones by Kenneth H. Muelle, 18 November 1978
- ^ Nevil Shute, On the Beach, New York, William Morrow and Company, 1957. (See p. 296 identifying the red cartons as Nembutal).