Pentobarbital is a short-acting
barbiturateBarbiturates are drugs that act as central nervous system depressants, and, by virtue of this, they produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, hypnotics and as anticonvulsants. They have addiction potential, both physical and...
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
ethanolEthanol, also called ethyl alcohol, pure alcohol, grain alcohol, or drinking alcohol, is a volatile, flammable, colorless liquid. It is a psychoactive drug, best known as the type of alcohol found in alcoholic beverages and in modern thermometers. Ethanol is one of the oldest recreational drugs...
. 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 (
sodiumSodium is a metallic element with a symbol Na and atomic number 11. It is a soft, silvery-white, highly reactive metal and is a member of the alkali metals within "group 1"...
) +
ethylIn chemistry, an ethyl group is an alkyl functional group derived from ethane . It has the formula -C
2H
5 and is very often abbreviated -Et....
+
methyl +
butylIn organic chemistry, butyl is a four-carbon alkyl substituent with chemical formula -C4H9 . It is derived from either of the two isomers of the alkane called butane....
+
al (common suffix for barbiturates).
Pentobarbital's
FDAThe Food and Drug Administration is a Government agency of the United States Department of Health and Human Services and is responsible for regulating and supervising the safety of foods, tobacco products, dietary supplements, Medication drugs, vaccines, Biopharmaceutical, blood transfusion,...
approved human uses include treatment of
seizureAn epileptic seizure is a transient symptom of excessive or synchronous neuronal activity in the brain. It can manifest as an alteration in mental state, tonic or clonic movements, convulsions, and various other psychic symptoms...
s
and preoperative (and other)
sedationSedation is a medical procedure involving the administration of sedative drugs, generally to facilitate a medical procedure with local anaesthesia.- Uses :...
; it is also approved as a short-term
hypnoticHypnotic drugs are a class of psychoactives whose primary function is to induce sleep and to be used in the treatment of insomnia and in surgical anesthesia. Because drugs in this class generally produce dose-dependent effects, ranging from anxiolysis to production of unconsciousness, they are...
.
In France and the Netherlands, it is no longer used in the treatment of
insomniaInsomnia is a symptom of any of several sleep disorders, characterized by persistent difficulty falling asleep or staying asleep despite the opportunity. Insomnia is a symptom, not a stand-alone diagnosis or a disease. By definition, insomnia is "difficulty initiating or maintaining sleep, or both"...
, nor as a preanesthetic.
Off-label uses of pentobarbital include reduction of intracranial pressure in
Reye's syndromeReye's syndrome is a potentially fatal disease that causes numerous detrimental effects to many organs, especially the brain and liver, as well as causing hypoglycemia...
, traumatic brain injury and induction of coma in
cerebral ischemiaBrain ischemia, also known as cerebral ischemia, is a condition in which there is insufficient blood flow to the brain to meet metabolic demand. This leads to poor oxygen supply or cerebral hypoxia and thus to the death of brain tissue or cerebral infarction / ischemic stroke...
patients.
In
veterinary medicineVeterinary medicine is the application of medical, diagnostic, surgical, dental, and therapeutic principles to companion, domestic, exotic, wildlife, and production animals. Veterinary science is vital to the study and protection of animal production practices, herd health and monitoring the spread...
, sodium pentobarbital—traded under names such as
Sagatal—is used as an anaesthetic.
Pentobarbital is a short-acting
barbiturateBarbiturates are drugs that act as central nervous system depressants, and, by virtue of this, they produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, hypnotics and as anticonvulsants. They have addiction potential, both physical and...
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
ethanolEthanol, also called ethyl alcohol, pure alcohol, grain alcohol, or drinking alcohol, is a volatile, flammable, colorless liquid. It is a psychoactive drug, best known as the type of alcohol found in alcoholic beverages and in modern thermometers. Ethanol is one of the oldest recreational drugs...
. 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 (
sodiumSodium is a metallic element with a symbol Na and atomic number 11. It is a soft, silvery-white, highly reactive metal and is a member of the alkali metals within "group 1"...
) +
ethylIn chemistry, an ethyl group is an alkyl functional group derived from ethane . It has the formula -C
2H
5 and is very often abbreviated -Et....
+
methyl +
butylIn organic chemistry, butyl is a four-carbon alkyl substituent with chemical formula -C4H9 . It is derived from either of the two isomers of the alkane called butane....
+
al (common suffix for barbiturates).
Approved
Pentobarbital's
FDAThe Food and Drug Administration is a Government agency of the United States Department of Health and Human Services and is responsible for regulating and supervising the safety of foods, tobacco products, dietary supplements, Medication drugs, vaccines, Biopharmaceutical, blood transfusion,...
approved human uses include treatment of
seizureAn epileptic seizure is a transient symptom of excessive or synchronous neuronal activity in the brain. It can manifest as an alteration in mental state, tonic or clonic movements, convulsions, and various other psychic symptoms...
s
and preoperative (and other)
sedationSedation is a medical procedure involving the administration of sedative drugs, generally to facilitate a medical procedure with local anaesthesia.- Uses :...
; it is also approved as a short-term
hypnoticHypnotic drugs are a class of psychoactives whose primary function is to induce sleep and to be used in the treatment of insomnia and in surgical anesthesia. Because drugs in this class generally produce dose-dependent effects, ranging from anxiolysis to production of unconsciousness, they are...
.
In France and the Netherlands, it is no longer used in the treatment of
insomniaInsomnia is a symptom of any of several sleep disorders, characterized by persistent difficulty falling asleep or staying asleep despite the opportunity. Insomnia is a symptom, not a stand-alone diagnosis or a disease. By definition, insomnia is "difficulty initiating or maintaining sleep, or both"...
, nor as a preanesthetic.
Unapproved/Investigational/Off-Label
Off-label uses of pentobarbital include reduction of intracranial pressure in
Reye's syndromeReye's syndrome is a potentially fatal disease that causes numerous detrimental effects to many organs, especially the brain and liver, as well as causing hypoglycemia...
, traumatic brain injury and induction of coma in
cerebral ischemiaBrain ischemia, also known as cerebral ischemia, is a condition in which there is insufficient blood flow to the brain to meet metabolic demand. This leads to poor oxygen supply or cerebral hypoxia and thus to the death of brain tissue or cerebral infarction / ischemic stroke...
patients.
Veterinary medicine
In
veterinary medicineVeterinary medicine is the application of medical, diagnostic, surgical, dental, and therapeutic principles to companion, domestic, exotic, wildlife, and production animals. Veterinary science is vital to the study and protection of animal production practices, herd health and monitoring the spread...
, sodium pentobarbital—traded under names such as
Sagatal—is used as an anaesthetic. Pentobarbital is an ingredient in
EquithesinEquithesin is the proprietary name for a commercial mixture of chloral hydrate, magnesium sulfate and pentobarbital sodium that was used as a general anesthetic in horses. Equithesin was administered intra-venously to effect and for many years was the most commonly used injectable anesthetic in...
.
Veterinary euthanasia
It is used by itself, or more often in combination with complementary agents such as
phenytoinPhenytoin sodium is a commonly used antiepileptic. Phenytoin acts to dampen the unwanted, runaway brain activity seen in seizure by reducing electrical conductance among brain cells by stabilizing the inactive state of voltage gated sodium channels...
, in commercial
animal euthanasiaAnimal euthanasia is the act of inducing humane death in an animal. Euthanasia methods are designed to cause minimal pain and distress....
injectable solutions. Trade names include
Euthasol,
Euthatal,
Euthanal,
Euthanyl (in Canada),
Beuthanasia-D, and
Fatal Plus.
Human euthanasia
In the
NetherlandsThe Netherlands is a country in Northwestern Europe, constituting the major portion of the Kingdom of the Netherlands. It is a parliamentary democratic constitutional monarchy. The Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east...
, 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.
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
OregonOregon is a state in the Pacific Northwest region of the United States. It is located on the Pacific coast, with Washington to the north, California to the south, Nevada on the southeast and Idaho to the east. The Columbia and Snake rivers delineate much of Oregon's northern and eastern...
for this purpose., and is also used by the euthanasia group
DignitasDignitas is a Swiss assisted dying group that helps those with terminal illness and severe physical and mental illnesses to die assisted by qualified doctors and nurses...
. Pentobarbital was also used for this purpose in the
Northern TerritoryThe Northern Territory is a federal territory of Australia, occupying much of the centre of the mainland continent, as well as the central northern regions...
of
AustraliaAustralia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the continental mainland , the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans...
, prior to euthanasia becoming illegal in that region.
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
smuggledSmuggling, also known as trafficking, is the clandestine transportation of goods or persons past a point where prohibited, such as out of a building, into a prison, or across an international border, in violation of applicable laws or other regulations.There are various motivations to smuggle...
across borders from countries where it is still available
over-the-counterOver-the-counter drugs are medicines that may be sold to a customer without a prescription from a health care professional, as compared to prescription drugs, which may only be sold to customers possessing a valid prescription...
, or purchased through illegal
mail ordersMail order is a term which describes the buying of goods or services by mail delivery. The buyer places an order for the desired products with the merchant through some remote method such as through a telephone call or web site. Then, the products are delivered to the customer...
. It has been described as one of the most peaceful ways to commit
suicideSuicide is the intentional killing of one's self. Many dictionaries also note the metaphorical sense of "willful destruction of one's self-interest"...
.
Death penalty
Sodium pentobarbital is also used for executions by
lethal injectionLethal injection refers to the practice of injecting a criminal with a fatal dose of drugs for the express purpose of executing the subject...
in
ChinaExecution vans, also referred to as "mobile execution units", were developed by the government of the People's Republic of China and were first used in 1997. Prisoners are strapped to a stretcher and executed via lethal injection inside the van. The vans allow for death sentences to be carried out...
, not in the United States.
Metabolism
Pentobarbital undergoes
first-pass metabolismThe first-pass effect is a phenomenon of drug metabolism whereby the concentration of a drug is greatly reduced before it reaches the systemic circulation...
in the liver and possibly the intestines.
Drug interactions
Administration of
alcoholIn chemistry, an alcohol is any organic compound in which a hydroxyl group is bound to a carbon atom of an alkyl or substituted alkyl group. An important group of acohols is formed by the simple acyclic alcohols, the general formula for which is C
nH
2n+1OH...
,
opioidAn opioid is a chemical that works by binding to opioid receptors, which are found principally in the central nervous system and the gastrointestinal tract...
s,
antihistamineAn H
1 antagonist is a histamine antagonist of the H
1 receptor that serves to reduce or eliminate effects mediated by histamine, an endogenous chemical mediator released during allergic reactions...
s, other
sedative-hypnoticA sedative is a substance that induces sedation by reducing irritability or excitement.At higher doses it may result in slurred speech, staggering gait, poor judgment, and slow, uncertain reflexes...
s, and other
central nervous systemThe central nervous system is the part of the nervous system that functions to coordinate the activity of all parts of the bodies of bilaterian animals—that is, all animals more advanced than sponges or jellyfish. In vertebrates, the central nervous system is enclosed in the meninges. It contains...
depressants will greatly increase the sedation effects and risk of accidental death caused by pentobarbital.
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.