Pentobarbital
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2,4,6(1H,3H,5H)-pyrimidinetrione
D (USA)
USA: Schedule II (oral and parenteral); Schedule III (rectal)
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]
Contents
[edit] Uses
[edit] 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]
[edit] 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]
[edit] 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.
[edit] 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.
[edit] 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.
Pentobarbital has also been used for physician assisted suicide. It is commonly used in Oregon for this purpose.[7], 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.
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.[8] When orally ingested for euthanasia purposes, an anti-emetic drug is frequently swallowed approximately 30 minutes before the lethal dose of pentobarbital.
[edit] Metabolism
Pentobarbital undergoes first-pass metabolism in the liver and possibly the intestines.[9]
[edit] 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]
[edit] 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 rumored to reference 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.
