Description
Barbiturates (bar-BI-tyoo-rates)
belong
to the group of medicines called central nervous system (CNS) depressants
(medicines that cause drowsiness). They act on the brain and CNS to produce
effects that may be helpful or harmful. This depends on the individual patient's
condition and response and the amount of medicine taken.
Some of the barbiturates may be used before surgery to relieve anxiety
or tension. In addition, some of the barbiturates are used as anticonvulsants
to help control seizures in certain disorders or diseases, such as epilepsy.
Barbiturates may also be used for other conditions as determined by your doctor.
The barbiturates have been used to treat insomnia (trouble in sleeping);
but if they are used regularly (for example, every day) for insomnia, they
are usually not effective for longer than 2 weeks. The barbiturates have also
been used to relieve nervousness or restlessness during the daytime. However,
the barbiturates have generally been replaced by safer medicines for the treatment
of insomnia and daytime nervousness or tension.
If too much of a barbiturate is used, it may become habit-forming.
Barbiturates should not be used for anxiety or tension caused by the stress
of everyday life.
These medicines are available only with your doctor's prescription, in
the following dosage forms:
Oral
-
Amobarbital
-
Capsules
(U.S. and Canada)
-
Tablets (U.S. and Canada)
-
Aprobarbital
-
Butabarbital
-
Capsules (U.S.)
-
Elixir (U.S.)
-
Tablets (U.S. and Canada)
-
Mephobarbital
-
Tablets (U.S. and Canada)
-
Metharbital
-
Tablets (Other countries)
-
Pentobarbital
-
Capsules (U.S. and Canada)
-
Elixir (U.S.)
-
Phenobarbital
-
Capsules (U.S.)
-
Elixir (U.S. and Canada)
-
Tablets (U.S. and Canada)
-
Secobarbital
-
Capsules (U.S. and Canada)
-
Secobarbital and Amobarbital
-
Capsules
(U.S. and Canada)
Parenteral
-
Amobarbital
-
Injection
(U.S. and Canada)
-
Pentobarbital
-
Injection (U.S. and Canada)
-
Phenobarbital
-
Injection (U.S. and Canada)
-
Secobarbital
Rectal
-
Pentobarbital
-
Suppositories (U.S. and Canada)
Before Using This Medicine
In deciding to use a medicine,
the risks of taking the medicine must be weighed against the good it will
do. This is a decision you and your doctor will make. For barbiturates, the
following should be considered:
Allergies--Tell your doctor if you have ever had any unusual or
allergic reaction to barbiturates. Also tell your health care professional
if you are allergic to any other substances, such as foods, preservatives,
or dyes.
Pregnancy--Barbiturates have been shown to increase the chance
of birth defects in humans. However, this medicine may be needed in serious
diseases or other situations that threaten the mother's life. Be sure you
have discussed this and the following information with your doctor:
-
Taking barbiturates regularly during pregnancy may cause bleeding
problems in the newborn infant. In addition, taking barbiturates regularly
during the last 3 months of pregnancy may cause the baby to become dependent
on the medicine. This may lead to withdrawal side effects in the baby after
birth.
-
One study in humans has suggested that barbiturates taken during
pregnancy may increase the chance of brain tumors in the baby.
-
Barbiturates taken for anesthesia during labor and delivery may reduce
the force and frequency of contractions of the uterus; this may prolong labor
and delay delivery.
-
Use of barbiturates during labor may cause breathing problems in
the newborn infant.
Breast-feeding--Barbiturates pass into the breast milk and
may cause drowsiness, slow heartbeat,
shortness of breath, or troubled breathing in babies of nursing mothers taking
this medicine.
Children--Unusual excitement may be more likely to occur
in children, who are usually
more sensitive than adults to the effects of barbiturates.
Older adults--Confusion, mental depression, and unusual excitement
may be more likely
to occur in the elderly, who are usually more sensitive than younger adults
to the effects of barbiturates.
Other medicines--Although certain medicines should not be used
together at all, in other
cases 2 different medicines may be used together even if an interaction might
occur. In these cases, your doctor may want to change the dose, or other precautions
may be necessary. When you are taking a barbiturate, it is especially important
that your health care professional know if you are taking any of the following:
-
Adrenocorticoids (cortisone-like medicine) or
-
Anticoagulants (blood thinners) or
-
Carbamazepine or
-
Corticotropin (ACTH)--Barbiturates may decrease the effects
of these medicines
-
Central nervous system (CNS) depressants (medicines that cause drowsiness)--Using
these medicines with barbiturates may result in increased CNS depressant effects
-
Divalproex sodium or
-
Valproic acid--Using these medicines with barbiturates may change
the amount of either medicine that you need to take
-
Oral contraceptives (birth control pills) containing estrogens--Barbiturates
may decrease the effectiveness of these oral contraceptives, and you may need
to change to a different type of birth control
Other medical problems--The presence of other medical problems may affect
the use of barbiturates. Make sure you tell your doctor if you have any other
medical problems, especially:
-
Alcohol abuse (or history of) or
-
Drug abuse or dependence (or history of)--Dependence on barbiturates
may develop
-
Anemia (severe) or
-
Asthma (history of), emphysema, or other chronic lung disease or
-
Diabetes mellitus (sugar diabetes) or
-
Hyperactivity (in children) or
-
Mental depression or
-
Overactive thyroid or
-
Porphyria (or history of)--Barbiturates may make the condition
worse
-
Kidney disease or
-
Liver disease--Higher blood levels of barbiturates may result,
increasing the chance of side effects
-
Pain--Barbiturates may cause unexpected excitement or mask important
symptoms of more serious problems
-
Underactive adrenal gland--Barbiturates may interfere with the
effects of other medicines needed for this condition
Proper Use of This Medicine
For patients taking the
extended-release capsule or tablet form
of this medicine:
-
These capsules or tablets are to be swallowed whole. Do not break,
crush, or chew before swallowing.
For patients using the
rectal suppository form
of this medicine:
-
To insert the suppository: First remove the foil wrapper and moisten
the suppository with cold water. Lie down on your side and use your finger
to push the suppository well up into the rectum.
-
Wash your hands with soap and water.
Use this medicine only as directed by your doctor
.
Do not use more of it, do not use it more often, and do not use it for a longer
time than your doctor ordered. If too much is used, it may become habit-forming
(causing mental or physical dependence).
If you think this medicine is not working properly after you have taken
it for a few weeks,
do not increase the dose
. To
do so may increase the chance of your becoming dependent on the medicine.
Instead, check with your doctor.
If you are taking this medicine for epilepsy, it must
be taken every day in regularly spaced doses as ordered by your doctor in
order for it to control your seizures
. This is necessary to keep a
constant amount of medicine in the blood. To help keep the amount constant,
do not miss any doses.
Dosing--The dose of barbiturates will be different
for different patients.
Follow your doctor's orders or
the directions on the label
. The following information includes only
the average doses of barbiturates.
If your dose is different,
do not change it
unless your doctor tells you to do so.
The number of capsules, tablets, or teaspoonfuls of elixir that you take,
the number of suppositories you use, or the number of injections you receive
depends on the strength of the medicine. Also,
the number
of doses you take each day, the time allowed between doses, and the length
of time you take the medicine depend on the medical problem for which you
are taking barbiturates
.
For amobarbital
-
For
oral
dosage
form (tablets or capsules):
-
For trouble in sleeping:
-
Adults--65 to 200 milligrams (mg) at bedtime.
-
Children--Dose must be determined by your doctor.
-
For daytime sedation:
-
Adults--50
to 300 mg, taken in smaller doses during the day.
-
Children--Dose is based on body weight or size and must be determined
by your doctor. The usual dose is 2 mg per kilogram (kg) (0.9 mg per pound)
of body weight taken three times a day.
-
For sedation before surgery:
-
Adults--200
mg taken one to two hours before surgery.
-
Children--Dose is based on body weight and must be determined
by your doctor. The usual dose is 2 to 6 mg per kg (0.9 to 2.7 mg per pound)
of body weight, taken before surgery. However, the dose is usually not more
than 100 mg.
-
For sedation during labor:
-
Adults--200
to 400 mg every one to three hours if needed. However, the total dose is usually
not more than 1000 mg.
-
For
injection
dosage form:
-
For trouble in sleeping:
-
Adults--65
to 200 mg, injected into a muscle or vein.
-
Children up to 6 years of age--Dose is based on body weight
and must be determined by your doctor. The usual dose is 2 to 3 mg per kg
(0.9 to 1.4 mg per pound) of body weight, injected into a muscle.
-
Children 6 years of age and over--Dose is based on body weight
and must be determined by your doctor. The usual dose is 2 to 3 mg per kg
(0.9 to 1.4 mg per pound) of body weight, injected into a muscle, or 65 to
500 mg injected into a vein.
-
For daytime sedation:
-
Adults--30
to 50 mg two or three times a day, injected into a muscle or vein.
-
For sedation before surgery:
-
Children--Dose
is based on body weight and must be determined by your doctor. The usual dose
is 3 to 5 mg per kg (1.4 to 2.3 mg per pound) of body weight or 65 to 500
mg per dose, injected into a vein.
-
For control of seizures:
-
Adults and children
6 years of age and over--65 to 500 mg per dose, injected into a vein.
-
Children up to 6 years of age--Dose is based on body weight
or size and must be determined by your doctor. The usual dose is 3 to 5 mg
per kg (1.4 to 2.3 mg per pound) of body weight, injected into a muscle or
vein.
For aprobarbital
-
For
oral
dosage form (elixir):
-
For trouble in sleeping:
-
Adults--40 to 160 milligrams (mg) at bedtime.
-
Children--Dose must be determined by your doctor.
-
For daytime sedation:
-
Adults--40
mg three times a day.
-
Children--Dose must be determined by your doctor.
For butabarbital
-
For
oral
dosage form (elixir or tablets):
-
For trouble in
sleeping:
-
Adults--50 to 100 milligrams (mg)
at bedtime.
-
Children--Dose must be determined by your doctor.
-
For daytime sedation:
-
Adults--15
to 30 mg three or four times a day.
-
Children--Dose is based on body weight or size and must be determined
by your doctor. The usual dose is 2 mg per kilogram (kg) (0.9 mg per pound)
of body weight three times a day.
-
For sedation before surgery:
-
Adults--50
to 100 mg sixty to ninety minutes before surgery.
-
Children--Dose is based on body weight and must be determined
by your doctor. The usual dose is 2 to 6 mg per kg (0.9 to 2.7 mg per pound)
of body weight. However, the dose is usually not more than 100 mg.
For mephobarbital
-
For
oral
dosage form (tablets):
-
For daytime sedation:
-
Adults--32 to 100 milligrams (mg) three or four
times a day.
-
Children--16 to 32 mg three or four times a day.
-
For control of seizures:
-
Adults--200
to 600 mg a day, taken in smaller doses during the day.
-
Children up to 5 years of age--16 to 32 mg three or four times
a day.
-
Children 5 years of age and over--32 to 64 mg three or four
times a day.
For metharbital
-
For
oral
dosage
form (tablets):
-
For control of seizures:
-
Adults--At first, 100 milligrams (mg) one to three times a day.
Your doctor may increase your dose if needed. However, the dose is usually
not more than 800 mg a day.
-
Children--50 mg one to three times a day.
For pentobarbital
-
For
oral
dosage form (elixir or capsules):
-
For trouble in
sleeping:
-
Adults--100 milligrams (mg) at
bedtime.
-
Children--Dose must be determined by your doctor.
-
For daytime sedation:
-
Adults--20
mg three or four times a day.
-
Children--Dose is based on body weight and must be determined
by your doctor. The usual dose is 2 to 6 mg per kilogram (kg) (0.9 to 2.7
mg per pound) of body weight per day.
-
For sedation before surgery:
-
Adults--100
mg before surgery.
-
Children--Dose is based on body weight and must be determined
by your doctor. The usual dose is 2 to 6 mg per kilogram (0.9 to 2.7 mg per
pound) of body weight, taken before surgery. However, the dose is usually
not more than 100 mg.
-
For
injection
dosage form:
-
For trouble in sleeping:
-
Adults--150
to 200 mg, injected into a muscle. Or, 100 mg injected into a vein, with additional
small doses given if needed. However, the dose is usually not more than 500
mg.
-
Children--Dose is based on body weight and must be determined
by your doctor. The usual dose is 2 to 6 mg per kg (0.9 to 2.7 mg per pound)
of body weight, injected into a muscle. Or, 50 mg injected into a vein, with
additional small doses given if needed.
-
For sedation before surgery:
-
Adults--150
to 200 mg, injected into a muscle.
-
Children--Dose is based on body weight and must be determined
by your doctor. The usual dose is 2 to 6 mg per kg (0.9 to 2.7 mg per pound)
of body weight, injected into a muscle. However, the dose is usually not more
than 100 mg.
-
For control of seizures:
-
Adults--At
first, 100 mg injected into a vein. Additional small doses may be given if
needed. However, the dose is usually not more than 500 mg.
-
Children--At first, 50 mg injected into a muscle or vein. Additional
small doses may be given if needed.
-
For
rectal
dosage form (suppositories):
-
For trouble in sleeping:
-
Adults--120 to 200 mg inserted into the rectum at bedtime.
-
Children up to 2 months of age--Dose must be determined by your
doctor.
-
Children 2 months to 1 year of age--30 mg inserted into the
rectum at bedtime.
-
Children 1 to 4 years of age--30 or 60 mg inserted into the
rectum at bedtime.
-
Children 5 to 12 years of age--60 mg inserted into the rectum
at bedtime.
-
Children 12 to 14 years of age--60 or 120 mg inserted into the
rectum at bedtime.
-
For daytime sedation:
-
Adults--30
mg inserted into the rectum two to four times a day.
-
Children--Dose is based on body weight or size and must be determined
by your doctor. The usual dose is 2 mg per kg (0.9 mg per pound) of body weight,
inserted into the rectum three times a day.
-
For sedation before surgery:
-
Children
up to 2 months of age--Dose must be determined by your doctor.
-
Children 2 months to 1 year of age--30 mg inserted into the
rectum.
-
Children 1 to 4 years of age--30 or 60 mg inserted into the
rectum.
-
Children 5 to 12 years of age--60 mg inserted into the rectum.
-
Children 12 to 14 years of age--60 or 120 mg inserted into the
rectum.
For phenobarbital
-
For
oral
dosage form (elixir, capsules, or tablets):
-
For
trouble in sleeping:
-
Adults--100 to 320 milligrams
(mg) at bedtime.
-
Children--Dose must be determined by your doctor.
-
For daytime sedation:
-
Adults--30
to 120 mg a day, taken in smaller doses two or three times during the day.
-
Children--Dose is based on body weight or size and must be determined
by your doctor. The usual dose is 2 mg per kilogram (kg) (0.9 mg per pound)
of body weight three times a day.
-
For sedation before surgery:
-
Children--Dose
is based on body weight and must be determined by your doctor. The usual dose
is 1 to 3 mg per kg (0.45 to 1.4 mg per pound) of body weight.
-
For control of seizures:
-
Adults--60
to 250 mg a day.
-
Children--Dose is based on body weight and must be determined
by your doctor. The usual dose is 1 to 6 mg per kg (0.45 to 2.7 mg per pound)
of body weight a day.
-
For
injection
dosage form:
-
For trouble in sleeping:
-
Adults--100
to 325 mg, injected into a muscle or vein, or under the skin.
-
Children--Dose must be determined by your doctor.
-
For daytime sedation:
-
Adults--30
to 120 mg a day, injected into a muscle or a vein, or under the skin, in smaller
doses two or three times during the day,
-
Children--Dose must be determined by your doctor.
-
For sedation before surgery:
-
Adults--130
to 200 mg, injected into a muscle sixty to ninety minutes before surgery.
-
Children--Dose is based on body weight and must be determined
by your doctor. The usual dose is 1 to 3 mg per kg (0.45 to 1.4 mg per pound)
of body weight, injected into a muscle or vein sixty to ninety minutes before
surgery.
-
For control of seizures:
-
Adults--100
to 320 mg injected into a vein. The dose may be repeated if needed, but is
usually not more than 600 mg a day. However, higher doses may be needed for
certain types of continuing seizures.
-
Children--Dose is based on body weight and must be determined
by your doctor. At first, the usual dose is 10 to 20 mg per kg (4.5 to 9 mg
per pound) of body weight, injected into a vein. Later, 1 to 6 mg per kg (0.45
to 2.7 mg per pound) of body weight a day, injected into a vein. Higher doses
may be needed for certain types of continuing seizures.
For secobarbital
-
For
oral
dosage form (capsules):
-
For trouble in sleeping:
-
Adults--100 milligrams (mg) at bedtime.
-
Children--Dose must be determined by your doctor.
-
For daytime sedation:
-
Adults--30
to 50 mg three or four times a day.
-
Children--Dose is based on body weight or size and must be determined
by your doctor. The usual dose is 2 mg per kilogram (kg) (0.9 mg per pound)
of body weight three times a day.
-
For sedation before surgery:
-
Adults--200
to 300 mg one or two hours before surgery.
-
Children--Dose is based on body weight and must be determined
by your doctor. The usual dose is 2 to 6 mg per kg (0.9 to 2.7 mg per pound)
of body weight one or two hours before surgery. However, the dose is usually
not more than 100 mg.
-
For
injection
dosage form:
-
For trouble in sleeping:
-
Adults--100
to 200 mg injected into a muscle, or 50 to 250 mg injected into a vein.
-
Children--Dose is based on body weight or size and must be determined
by your doctor. The usual dose is 3 to 5 mg per kg (1.4 to 2.3 mg per pound)
of body weight, injected into a muscle. However, the dose is usually not more
than 100 mg.
-
For sedation before dental procedures:
-
Adults--Dose is based on body weight and must be determined
by your
doctor. The usual dose is 1.1 to 2.2 mg per kg (0.5 to 1 mg per pound) of
body weight, injected into a muscle ten to fifteen minutes before the procedure.
-
Children--Dose must be determined by your dentist.
-
For sedation before a nerve block:
-
Adults--100
to 150 mg, injected into a vein.
-
For sedation before surgery:
-
Children--Dose
is based on body weight and must be determined by your doctor. The usual dose
is 4 to 5 mg per kg (1.8 to 2.3 mg per pound) of body weight, injected into
a muscle.
-
For seizures from tetanus:
-
Adults--Dose
is based on body weight and must be determined by your doctor. The usual dose
is 5.5 mg per kg (2.5 mg per pound) of body weight, injected into a muscle
or vein. Dose may be repeated every three to four hours if needed.
-
Children--Dose is based on body weight and must be determined
by your doctor. The usual dose is 3 to 5 mg per kg (1.4 to 2.3 mg per pound)
of body weight, injected into a muscle or vein.
For secobarbital and amobarbital combination
-
For
oral
dosage form (capsules):
-
For trouble in sleeping:
-
Adults--1 capsule
at bedtime.
-
Children--Dose must be determined by your doctor.
-
For sedation before surgery:
-
Adults--1
capsule taken one hour before surgery.
-
Children--Dose must be determined by your doctor.
Missed dose--If you are taking this medicine regularly (for
example, every day as in
epilepsy) and you do miss a dose, take it as soon as possible. However, if
it is almost time for your next dose, skip the missed dose and go back to
your regular dosing schedule. Do not double doses.
Storage--To store this medicine:
-
Keep out of the reach
of children since overdose is especially dangerous in children.
-
Store away from heat and direct light.
-
Do not store the capsule or tablet form of this medicine in the bathroom,
near the kitchen sink, or in other damp places. Heat or moisture may cause
the medicine to break down.
-
Keep the liquid form of this medicine from freezing.
-
Store the suppository form of this medicine in the refrigerator.
-
Do not keep outdated medicine or medicine no longer needed. Be sure
that any discarded medicine is out of the reach of children.
Precautions While Using This Medicine
If you
will be using this medicine regularly for a long time:
-
Your doctor should check your progress at regular visits.
-
Do not stop using it without first checking with your doctor. Your
doctor may want you to reduce gradually the amount you are using before stopping
completely.
This medicine will add to the effects of alcohol and other CNS depressants
(medicines that slow down the nervous system, possibly causing drowsiness).
Some examples of CNS depressants are antihistamines or medicine for hay fever,
other allergies, or colds; sedatives, tranquilizers, or sleeping medicine;
prescription pain medicine or narcotics; medicine for seizures; muscle relaxants;
or anesthetics, including some dental anesthetics.
Check
with your doctor before taking any of the above while you are using this medicine
.
Before you have any medical tests, tell the medical doctor in charge that
you are taking this medicine. The results of the metyrapone test may be affected
by this medicine.
If you have been using this medicine for a long time
and you think that you may have become mentally or physically dependent on
it, check with your doctor
. Some signs of mental or physical dependence
on barbiturates are:
-
a strong desire or need to
continue taking the medicine.
-
a need to increase the dose to receive the effects of the medicine.
-
withdrawal side effects (for example, anxiety or restlessness, convulsions
[seizures], feeling faint, nausea or vomiting, trembling of hands, trouble
in sleeping) occurring after the medicine is stopped.
If you think you or someone else may have taken an
overdose of this medicine, get emergency help at once
. Taking an overdose
of a barbiturate or taking alcohol or other CNS depressants with the barbiturate
may lead to unconsciousness and possibly death. Some signs of an overdose
are severe drowsiness, severe confusion, severe weakness, shortness of breath
or slow or troubled breathing, slurred speech, staggering, and slow heartbeat.
This medicine may cause some people to become dizzy, lightheaded, drowsy,
or less alert than they are normally. Even if taken at bedtime, it may cause
some people to feel drowsy or less alert on arising.
Make
sure you know how you react to this medicine before you drive, use machines,
or do anything else that could be dangerous if you are dizzy or are not alert
.
Oral contraceptives (birth control pills) containing
estrogen may not work properly if you take them while you are taking barbiturates.
Unplanned pregnancies may occur. You should use a different or additional
means of birth control while you are taking barbiturates
. If you have
any questions about this, check with your health care professional.
Side Effects of This Medicine
Along with its needed effects,
a medicine may cause some unwanted effects.
Although not all of these side effects may occur, if they do occur they may
need medical attention.
Check with your doctor
immediately
if any of
the following side effects occur:
Rare
Bleeding sores on lips; chest pain; fever; muscle or joint pain; red, thickened, or scaly skin; skin
rash or hives; sores, ulcers, or white spots in mouth
(painful); sore throat and/or fever; swelling of eyelids, face, or lips; wheezing or tightness in chest
Also, check with your doctor as soon as possible
if any of the following
side effects occur:
With long-term or chronic use
Bone pain, tenderness, or aching; loss
of appetite; muscle weakness; weight loss (unusual); yellow eyes or skin
Other side effects may occur that usually do not need medical
attention.
These side effects may go away during treatment as your body adjusts to the
medicine. However, check with your doctor if any of the following side effects
continue or are bothersome:
For very
ill patients:
-
Confusion, mental depression, and unusual excitement may be more
likely to occur in very ill patients
After you stop using this
medicine, your body may need time to adjust. If you took this medicine in
high doses or for a long time, this may take up to about 15 days. During this
period of time check with your doctor if any of the following side effects
occur (usually occur within 8 to 16 hours after medicine is stopped):
Anxiety or restlessness; convulsions
(seizures); dizziness or lightheadedness; feeling faint; hallucinations (seeing,
hearing, or feeling things that are not there); muscle twitching; nausea or vomiting; trembling of hands; trouble in sleeping,
increased dreaming, or nightmares; vision problems; weakness
Other
side effects not listed above may also occur in some patients. If you notice
any other effects, check with your doctor.
Additional Information
Once a medicine has been approved
for marketing for a certain use, experience may show that it is also useful
for other medical problems. Although this use is not included in product labeling,
phenobarbital is used in certain patients with the following medical condition:
-
Hyperbilirubinemia (high amount of bile pigments in the blood that
may lead to jaundice)
Other than the above information, there is no additional information relating
to proper use, precautions, or side effects for these uses.
