Pentobarbital
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| Clinical data | |
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| Routes of administration | Oral, Intravenous, Intramuscular, Rectal; also Intraperitoneal & Intracardiac (for animal euthanasia) |
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| Legal status |
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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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| CAS Number | |
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| CompTox Dashboard (EPA) | |
| ECHA InfoCard | 100.000.895 |
| Chemical and physical data | |
| Formula | C11H18N2O3 |
| Molar mass | 226.1319 g·mol−1 |
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.[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]
Veterinary Medicine
In veterinary medicine, sodium pentobarbital—traded under names such as Sagatal—is used as an anaesthetic.[5] 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[6] injectable solutions. Trade names include Euthasol, Euthatal, Euthanyl (in Canada), Beuthanasia-D, and Fatal Plus.
Human Euthanasia
In the Netherlands, a pentobarbital elixir is used as an alternative 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 euthanasia.
Drinking liquid pentobarbital is the form of suicide recommended in the book The Peaceful Pill Handbook which points out that the drug is readily (though illegally) available without prescription in Mexican veterinary drug stores.[7] Typically, when orally ingested for euthanasia purposes, an anti-emetic drug is swallowed approximately 30 minutes before the lethal overdose of pentobarbital. This is done because large, concentrated doses of pentobarbital may cause vomiting.
Assisted Suicide
Pentobarbital has also been used for physician assisted suicide. It is commonly used in Oregon for this purpose.[8], and is also used by the euthanasia group Dignitas. Pentobarbital was also used for this purpose in the Northern Territory of Australia, prior to euthanasia becoming illegal in that region.
Metabolism
Pentobarbital undergoes first-pass metabolism in the liver and possibly the intestines.[9]
Drug Interactions
Administration of alcohol, opioids, antihistamines, other sedative-hypnotics, and other central nervous system depressants will greatly increase the sedation caused by pentobarbital.[3]
Drug misuse
Pentobarbital is a drug with the potential for misuse. Two types of drug misuse can occur either recreational misuse is where the drug is taken to achieve a high or when the drug is continued long term against medical advice.[10]
Folklore
A pentobarbital suppository was cited in an October 2006 news article in WorldNetDaily.com as the cause of death of Marilyn Monroe.
The Clash makes a reference to it in the song The Right Profile from the album London Calling in which the lyrics read "Nembutal numbs it all, but I prefer... alcohol!"
The song "Yellow Submarine" by The Beatles is rumoured to refer to Nembutal due to the color and shape of the capsules. However, Paul McCartney has denied this, stating that he had written the song as a children's tune.
The song "Cerrado por Derribo" by Joaquín Sabina references Nembutal in its lyrics.
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. [11]
References and End Notes
- ^ a b "Pentobarbital". San Diego Reference Laboratory: Technical Help.
{{cite web}}: Unknown parameter|accessdaymonth=ignored (help); Unknown parameter|accessyear=ignored (|access-date=suggested) (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 edition ed.). F. A. Davis Company. p. 789. ISBN 978-0-8036-1154-2. Retrieved 2005-07-16.
{{cite book}}:|edition=has extra text (help); Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ VIDAL (2001). "PENTOBARBITAL SODIQUE". Banque de Données Automatisée sur les Médicaments.
{{cite web}}: Unknown parameter|accessmonthday=ignored (help); Unknown parameter|accessyear=ignored (|access-date=suggested) (help) - ^ UBC Committee on Animal Care (2005). "Euthanasia". SOP 009E1 - euthanasia - overdose with pentobarbital. The University of British Columbia.
{{cite web}}: Unknown parameter|accessdaymonth=ignored (help); Unknown parameter|accessyear=ignored (|access-date=suggested) (help) - ^ Unknown (2003). "ANESTHESIA AND ANALGESIA". Animal Use Protocols. University of Virginia.
{{cite web}}: Unknown parameter|accessdaymonth=ignored (help); Unknown parameter|accessyear=ignored (|access-date=suggested) (help) - ^ In Tijuana, a Market for Death in a Bottle, The New York Times, 21 July 2008
- ^ Goodenough, Patrick (2002-03-26). "Campaigners Rally Round Right-To-Die Woman". CNSNews.com.
{{cite web}}: Unknown parameter|accessmonthday=ignored (help); Unknown parameter|accessyear=ignored (|access-date=suggested) (help) - ^ 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