What is sodium pentobarbital used for?

Pentobarbital is a barbiturate that acts as a depressant, or sedative, used short-term to treat insomnia. Pentobarbital is also used as an emergency treatment for seizures, and to cause patients to fall asleep for surgery.

Can you buy pentobarbital?Pentobarbital is readily available without prescription on the Internet. Although there is little public awareness about this drug, current mediatisation of assisted-suicide could lead to an increased interest from suicide attempters. order here

Pentobarbital is a medication used in the management and treatment of several medical conditions including seizures, intracranial pressure control, insomnia, and as a pre-anesthetic in the operating room. This activity reviews the indications, mechanism of action, administration, adverse effects, and contraindications of pentobarbital therapy in the clinical setting. It is intended to relate the essential points needed by members of an interprofessional team managing the care of patients undergoing treatment with pentobarbital and its related conditions and sequelae.

Objectives:

  • Identify the mechanism of action of pentobarbital.
  • Describe the adverse effects and contraindications of pentobarbital.
  • Review the appropriate monitoring for the toxicity of pentobarbital.
  • Explain interprofessional team strategies for improving care coordination and communication to advance the use of pentobarbital and improve outcomes.

Typical applications for pentobarbital are sedative, short term hypnotic, preanesthetic, insomnia treatment, and control of convulsions in emergencies. Abbott Pharmaceutical discontinued manufacture of their Nembutal brand of Pentobarbital capsules in 1999, largely replaced by the benzodiazepine family of drugs. Pentobarbital was also widely abused, known on the street as “yellow jackets”. They were available as 30, 50, and 100-milligram capsules of yellow, white-orange, and yellow colors, respectively.

It is also used as a veterinary anesthetic agent.

Pentobarbital also has an application in reducing intracranial pressure in Reye’s syndrome, traumatic brain injury and induction of coma in cerebral ischemia patients. Pentobarbital-induced coma has been advocated in patients with acute liver failure refractory to mannitol.

Euthanasia

Pentobarbital can cause death when used in high doses. It is used for euthanasia for humans as well as animals. It is also used by itself, or in combination with complementary agents such as phenytoin, in commercial animal euthanasia injectable solutions.

Pentobarbital Sodium (CAS No. 57-33-0)

In the Netherlands, it is part of the standard protocol for physician-assisted suicide for self-administration by the patient.

It is also used by mouth for physician-assisted death in the United States states of Oregon, Washington, Vermont, and California (as of January, 2016).

The oral dosage of pentobarbital indicated for physician-assisted suicide in Oregon, US is typically 10 g in liquid form.

Execution

Pentobarbital has been used or considered as a substitute for other drugs traditionally used for capital punishment in the United States when they are in short supply. Such use however is illegal under Danish law, and when this was discovered, after public outcry in Danish media, Lundbeck, the owner of the drug, stopped selling it to US states that impose the death penalty. US distributors of the drug are forbidden by the owner to sell it to any customers, such as several state authorities, that practice or participate in executions of humans.

Texas began using pentobarbital for executing death-row inmates by lethal injection on July 18, 2012. The use of pentobarbital has been considered by several states, including Ohio, Arizona, Idaho, and Washington; those states made the decision to switch following shortages of pancuronium bromide, a muscle paralytic previously used as one component in a three-drug cocktail.

In October 2013, Missouri changed its protocols to allow for a compounded pentobarbital to be used in a lethal dose for executions and it was first used in November 2013.

According to a December 2019 ProPublica article, by 2017, the Bureau of Prisons (BOP) in discussion with then Attorney General Jeff Sessions, had begun to search for suppliers of pentobarbital to be used in lethal injections. The BOP were aware that courts would challenge the use of pentobarbital as their “new drug choice” as some lawyers have said that “pentobarbital would flood prisoners’ lungs with froth and foam, inflicting pain and terror akin to a death by drowning.” BOP said that these concerns were not justified and that their two expert witness said that the use of pentobarbital was “humane”. On July 25, 2019, US Attorney General William Barr directed the federal government to resume capital punishment after 16 years. The drug of choice for these executions is pentobarbital.

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