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Barbiturates - Some Benefits on Usage of Barbiturates

Type of Drug:

Central nervous system (CNS) depressants; sedatives; antianxiety agents; anticonvulsants; "barbs"; "downers."

How the Drug Works:

Barbiturates are capable of producing all levels of CNS mood alternation, from excitation to mild sedation, sleep, and deep coma. They also decrease the severity and or frequency of certain types of seizures. Over­dose can produce death. In high therapeutic doses, barbiturates induce anesthesia. Barbiturates depress the sensory cortex, decrease motor activity, alter cerebellar function, and produce drowsiness, sedation, and hypnosis (sleep).

Uses:

  • To treat sleeplessness by inducing sleep (hypnotic). Do not use for more than 2 weeks. Other drugs have replaced barbiturates as primary sleep aids (all except mephobarbital, phenobarbital).

  • To calm down (sedate) patients who are agitated (all except pentobarbital injection).

  • To treat certain seizure disorders. Mephobarbital is indicated for the treatment of grand and petit mal epilepsy. Phenobarbital is indicated for the treatment of generalized and partial seizures. May be used alone or in combination with other medications

Precautions:

  • Vitamin D: requirements may be increased when taking barbiturates. Long­term barbiturate use may increase the chance for developing rickets or osteoporosis (weakening of bones).

  • Vitamin K: Bleeding in the early neonatal period due to coagulation defect may follow exposure to anticonvulsant drug in therefore, vitamin K should be given to the mother before delivery or to the child at birth.

  • Acute or chronic pain: Caution should be exercised when barbiturates are administered to patients with acute or chronic pain because paradoxical excitement could be induced or symptoms could be masked. However, use of barbiturates as sedatives in postoperative surgical period and as adjunct to cancer chemotherapy is well established.

  • Steroid-dependent patients: Steroids (eg, hydrocortisone, prednisone) may lose some effect when barbiturates are started. Tell your doctor if you take steroid medications regularly.

  • Barbiturates may be habit formin:. Tolerance and dependence may Occur with continued use, especially following prolonged use of high doses. To minimize the possibility of over dosage or the development of dependence, the prescribing and dispensing of sedative-hypnotic barbiturates should be limited to the amount required for the interval until the next appointment.

  • Symptoms of acute intoxication: Include unsteady walk, slurred speech, and sustained involuntary eye movements. Mental signs of chronic intoxication include confusion, poor judgment, irritability, sleeplessness, and body aches.

  • Symptoms of dependence: Are similar to those of chronic alcoholism and include: A strong desire or need to continue taking the drug, tendency to increase the dose, and dependence on the effects of the drug.

  • Elderly or debilitated patients: May be more susceptible to side effects. Lower initial doses may be appropriate.

  • Pregnancy: Studies have shown a potential effect on the fetus. Withdrawal symptoms may Occur in infants born to women who receive barbituates throughout the last trimester of pregnancy. Use only if clearly needed and potential benefits outweigh the possible risks to the fetus.

  • Breastfeeding: Small amounts of barbiturates appear in breast milk. Drowsiness in the nursing infant has been reported. Consult your doctor before you begin breastfeeding.

  • Children: Safety and effectiveness have not been established for children younger than 6 years of age. Some children may become irritable, excitable, unexpectedly tearful, or aggressive when taking barbiturates.

  • Lab Tests: Lab tests may be required during long-term therapy. Tests may include blood counts and kidney and liver function tests.

  • Tartrazine: Some of these products may contain the dye tartrazine (FD&C Yellow No.5), which can cause allergic reactions in certain individuals. Check package label when available or consult your doctor or pharmacist.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or dietary supplements with barbiturates. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with barbiturates.

  • Alcohol anesthetics general (eg, methoxyflurane)

  • Anticoagulants (eg, warfarin)

  • Caramazepine (eg tegretol)

  • Corticosteroids (eg, prednisone)

  • MAOls (eg, phenelzine)

  • Methadone (eg, dolophine)

Side Effects:

Every drug is capable of producing side effects. Many barbiturate sedative users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

  • Withdrawal: Symptoms of withdrawal can be severe and may cause death. Minor symptoms may appear 8 to 12 hours after the last dose of a barbiturate and usually appear in the following order: Anxiety, muscle twitching, tremor of hands and fingers, progressive weakness, dizziness, visual perception problems, nausea, vomiting, sleeplessness, and dizziness or lightheadedness when arising from a seated or lying position. Major symptoms, including convulsions and delirium, may occur within 16 hours and last 5 days or less after abrupt stopping of these drugs. Intensity of withdrawal symptoms gradually declines over a period of approximately 15 days.

  • Digestive Tract: Nausea; vomiting; constipation.

  • Nervous System: Drowsiness; agitation; confusion; nightmares; hangover feeling; nervousness; hallucinations; sleeplessness; headache; depression; dizziness; stumbling gait.

  • Circulatory System: Slowed heart rate; decreased blood pressure. Respiratory System: Decreased breathing rate; difficulty breathing.

  • Other: Rash; pain; fever; anemia; injection site reactions; fainting.

Guidelines for Use:

  • Doses of barbiturates will be individualized with full knowledge of the patient's particular characteristics, including the patient's age, weight, the condition being treated, and other concurrent medical conditions and medications.

  • Take only the amount of drug prescribed by your doctor. Barbiturates may be habit forming both Psychologically and physically. Do not change the dose or discontinue therapy unless advised to do so by your doctor.

  • Seizures - When treating seizures with barbiturates, a barbiturate­induced depression may Occur along with a postictal depression once the seizures are controlled; therefore, it is important to use the minimal amount required and to wait for the anticonvulsant effect to develop before administering a second dose.

  • Too rapid administration of IV or IM dosing may cause respiratory depression, difficult breathing, larynx spasms, or flushing and redness of the skin with a fall in blood pressure.

  • Tell you doctor if you experience pain in the limbs during administration of an injection. This may be a sign of a serious condition. Parenteral solutions of barbiturates are highly alkaline and therefore extreme care should be taken to avoid perivascular extravasation or intra­arterial injection. Results of inappropriate injection may be local tissue damage and pain or gangrene to the limb.

  • Tell your doctor if you are pregnant, become pregnant, are planning to become pregnant, or if you are breastfeeding.

  • Oral contraceptive effectiveness may be decreased by barbituates. An alternative form of contraceptive (eg, barrier methods) is recommended.

  • May decrease alertness or physical ability. Use caution when driving or performing tasks requiring alertness, coordination, or physical dexterity.

  • Avoid alcohol and other mental depressants (eg, narcotics, tranquilizers, and antihistamines) while you are taking barbiturates.

  • Contact your doctor if you notice fever or excessive sedation.

  • Use as an aid to sleep is limited. Do not use for more than 2 weeks.

  • Seizure control - Do not stop therapy suddenly. Status epilepticus (severe, prolonged seizures) may result from the abrupt discontinuation of mephobarbital or phenobarbital, even when administered in small daily doses for treatment of epilepsy.

  • To avoid withdrawal symptoms after long-term use, a gradual dosage tapering schedule should be used.

  • Lab tests may be required during prolonged therapy. Be sure to keep appointments.

  • Store tablets, capsules, and elixirs at controlled room temperature (68 to 77°F) in a safe place, away from children.