Pharmacology. Pentobarbital is a short-acting barbiturate with anticonvulsant as well as sedative-hypnotic properties. It is used as a third-line drug in the treatment of status epilepticus. It also may reduce intracranial pressure in patients with cerebral edema by inducing vasoconstriction. After intravenous administration of a single dose, the onset of effect occurs within about 1 minute and lasts about 15 minutes. After intramuscular administration, the onset of effect is slower (10–15 minutes). Pentobarbital demonstrates a biphasic elimination pattern; the half-life of the initial phase is 4 hours, and the terminal phase half-life is 35–50 hours. Effects are prolonged after termination of a continuous infusion.

Indications

1. 
   

   Pentobarbital is used for the management of status epilepticus that is unresponsive to conventional anticonvulsant therapy (eg, diazepam, phenytoin, or phenobarbital). If the use of pentobarbital for seizure control is considered, consultation with a neurologist is recommended.

   
   
2. 
   

   Pentobarbital is used to manage elevated intracranial pressure in conjunction with other agents.

   
   
3. 
   

   It may be used therapeutically or diagnostically for patients with suspected alcohol or sedative-hypnotic drug withdrawal syndrome.

   
   
4. 
   

   It has been used to manage stimulant-induced agitation and sympathomimetic symptoms refractory to benzodiazepines.

Contraindications

1. 
   

   Known sensitivity to the drug.

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