Barbiturates
PREGNANCY CATEGORY D
PREGNANCY CATEGORY C (THIOPENTAL)
PREGNANCY CATEGORY B (METHOHEXITAL)
CONTROLLED SUBSTANCE C-II
Therapeutic Actions
Barbiturates act as sedatives, hypnotics, antiepileptics, and general anesthetics. They are general CNS depressants. Barbiturates inhibit impulse conduction in the ascending reticular activating system, depress the cerebral cortex, alter cerebellar function, depress motor output, and can produce excitation, sedation, hypnosis, anesthesia, and deep coma; at anesthetic doses, they have anticonvulsant activity.
Indications
Sedatives or hypnotics for short-term treatment of insomnia
Preanesthetic medications
Antiepileptics, in anesthetic doses, for emergency control of certain acute seizure episodes (eg, status epilepticus, eclampsia, meningitis, tetanus, toxic reactions to strychnine or local anesthetics)
Contraindications and Cautions
Contraindicated with hypersensitivity to barbiturates, manifest or latent porphyria, marked hepatic impairment, nephritis, severe respiratory distress, respiratory disease with dyspnea, obstruction, or cor pulmonale, previous addiction to sedative-hypnotic drugs, pregnancy (causes fetal damage, neonatal withdrawal syndrome), or lactation.
Use cautiously with acute or chronic pain (paradoxical excitement or masking of important symptoms could result), seizure disorders (abrupt discontinuation of daily doses of drug can result in status epilepticus), fever, hyperthyroidism, diabetes mellitus, severe anemia, pulmonary or cardiac disease, status asthmaticus, shock, uremia.
Adverse Effects
CNS: Somnolence, agitation, confusion, hyperkinesia, ataxia, vertigo, CNS depression, nightmares, lethargy, residual sedation (hangover), paradoxical excitement, nervousness, psychiatric disturbance, hallucinations, insomnia, anxiety, dizziness, abnormal thinking
CV: Bradycardia, hypotension, syncope
GI: Nausea, vomiting, constipation, diarrhea, epigastric pain
Hypersensitivity: Rashes, angioneurotic edema, serum sickness, morbilliform rash, urticaria; rarely, exfoliative dermatitis, Stevens-Johnson syndrome
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