Contraindications Hypersensitivity to barbiturates; manifest or latent porphyria.

 

Route/Dosage

Insomnia

ADULTS: PO/IV 100 mg (maximum IV rate 50 mg/min). IM/PR 120 to 200 mg (maximum IM dose 500 mg or 5 ml volume regardless of concentration).

Sedation

ADULTS: PO/PR 20 to 30 mg bid to qid. CHILDREN: PO/IM 2 to 6 mg/kg (maximum 100 mg). IV 50 mg.

Convulsions

ADULTS: IV Use minimum dose to avoid compounding depression. Administer slowly to allow time for drug to penetrate the blood-brain barrier. Do not exceed 50 mg/min.

Pediatric Patients Unable to Take Orally or by Injection

CHILDREN 12 to 14 YR (36.4 to 50 KG): PR 60 or 120 mg. CHILDREN 5 to 12 YR (18.2 to 36.4 KG) PR 60 mg. CHILDREN 1 to 4 YR (9 to 18.2 KG): PR 30 or 60 mg. CHILDREN 2 mo to 1 YR (4.5 to 9 KG): PR 30 mg.

 

Interactions

Alcohol, CNS depressants: May produce additive depressant effects. Anticoagulants, beta-blockers, calcium-channel blockers (eg, nifedipine, verapamil), theophylline: Activity of these drugs may be reduced. Anticonvulsants: Serum concentrations of carbamazepine, valproic acid and succinimides may be reduced. Valproic acid may increase barbiturate serum levels. Corticosteroids: Effectiveness may be reduced. Estrogen, estrogen-containing oral contraceptives: May cause decreased contraceptive and estrogen effect. Griseofulvin: Decreased griseofulvin levels.

 

Lab Test Interferences Decreased serum bilirubin concentrations, false-positive phentolamine test, decreased response to metyrapone and impaired absorption of radioactive cyanocobalamin.

 

Adverse Reactions

CV: Bradycardia; hypotension; syncope. CNS: Drowsiness; agitation; confusion; headache; hyperkinesia; ataxia; CNS depression; paradoxical excitement; nightmares; psychiatric disturbances; hallucinations; insomnia; dizziness. GI: Nausea; vomiting; constipation. HEPA: Liver damage. HEMA: Blood dyscrasias (eg, agranulocytosis, thrombocytopenia). RESP: Hypoventilation; apnea; laryngospasm; bronchospasm. OTHER: Hypersensitivity reactions (eg, angioedema, rashes, exfoliative dermatitis); fever; injection site reactions (eg, local pain, thrombophlebitis).

 

Precautions

Pregnancy: Category D. Lactation: Excreted in breast milk. Children: May respond with excitement rather than depression. Elderly patients: More sensitive to drug effects; dosage reduction is required. Dependence: Tolerance or psychological and physical dependence may occur with continued use. IV administration: Do not exceed maximum IV rate; respiratory depression, apnea and hypotension may result. Parenteral solutions are highly alkaline; extravasation may cause tissue damage and necrosis. Inadvertent intra-arterial injection may lead to arterial spasm, thrombosis, and gangrene. Renal or hepatic impairment: Use drug with caution; dosage reduction may be required. Seizure disorders: Status epilepticus may result from abrupt discontinuation.

PATIENT CARE CONSIDERATIONS

 

Administration/Storage

• Give IM injections deeply into large muscle. Do not exceed maximum IM dose of 500 mg or 5 ml of volume (regardless of concentration).
• For IV administration, inject into large vein; do not exceed maximum IV rate of 50 mg/min, do not administer into artery and do not allow perivascular extravasation.
• Administer with caution to patients with history of substance abuse.
• Do not use as sleep aid for > 2 wk.
• Store parenteral form at room temperature. Do not use if discolored or if precipitate forms.
• Store suppositories in refrigerator. Do not divide.

 

Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note presence of liver disease, respiratory disease, and porphyria.
• Observe for common side effects such as sedation or dizziness and report to physician.
• With prolonged therapy monitor lab test results for liver, renal, and hematopoietic functions.
• Monitor patient carefully during IV use for potential respiratory depression.
• Assess infants of lactating mothers and report drowsiness to physician.
• In children, monitor for possible paradoxical response of increased agitation and report to physician.
• Notify physician of the following signs of barbiturate intoxication: Unsteady gait, slurred speech, confusion or irritability.
• Watch for behavior indicative of drug dependency such as inordinate requests for more medication or need to refill prescription early.

OVERDOSAGE: SIGNS & SYMPTOMS   CNS and respiratory depression, Cheyne-Stokes respiration, areflexia, constriction of pupils, oliguria, tachycardia, hypotension, lowered body temperature, coma, apnea, circulatory collapse, respiratory arrest, death

 

Patient/Family Education

• Warn patient that medication may be habit forming and for this reason it is important to take medicine as directed. Taking too little or too much can have serious complications.
• Instruct patient to report the following symptoms to physician: Nausea, vomiting, drowsiness, dizziness, fever, sore throat, mouth sores, easy bleeding, bruising, skin irritation, or exaggerated sunburn.
• Caution patient to avoid intake of alcoholic beverages or other CNS depressants.
• Advise patient that drug may cause drowsiness, and to use caution while driving or performing other tasks requiring mental alertness.

Indications for Drugs ::

(pen-toe-BAR-bih-tahl SO-dee-uhm)

Nembutal Sodium,  Nova Rectal

Class: Sedative and hypnotic/Barbiturate/Short-acting/Anticonvulsant

 

Action Depresses sensory cortex, decreases motor activity, alters cerebellar function and produces drowsiness, sedation and hypnosis.

 

Indications Sedation; short-term treatment of insomnia; preanesthesia; emergency control of convulsions (parenteral form).

 

Contraindications Hypersensitivity to barbiturates; manifest or latent porphyria.

 

Route/Dosage

Insomnia

ADULTS: PO/IV 100 mg (maximum IV rate 50 mg/min). IM/PR 120 to 200 mg (maximum IM dose 500 mg or 5 ml volume regardless of concentration).

Sedation

ADULTS: PO/PR 20 to 30 mg bid to qid. CHILDREN: PO/IM 2 to 6 mg/kg (maximum 100 mg). IV 50 mg.

Convulsions

ADULTS: IV Use minimum dose to avoid compounding depression. Administer slowly to allow time for drug to penetrate the blood-brain barrier. Do not exceed 50 mg/min.

Pediatric Patients Unable to Take Orally or by Injection

CHILDREN 12 to 14 YR (36.4 to 50 KG): PR 60 or 120 mg. CHILDREN 5 to 12 YR (18.2 to 36.4 KG) PR 60 mg. CHILDREN 1 to 4 YR (9 to 18.2 KG): PR 30 or 60 mg. CHILDREN 2 mo to 1 YR (4.5 to 9 KG): PR 30 mg.

 

Interactions

Alcohol, CNS depressants: May produce additive depressant effects. Anticoagulants, beta-blockers, calcium-channel blockers (eg, nifedipine, verapamil), theophylline: Activity of these drugs may be reduced. Anticonvulsants: Serum concentrations of carbamazepine, valproic acid and succinimides may be reduced. Valproic acid may increase barbiturate serum levels. Corticosteroids: Effectiveness may be reduced. Estrogen, estrogen-containing oral contraceptives: May cause decreased contraceptive and estrogen effect. Griseofulvin: Decreased griseofulvin levels.

 

Lab Test Interferences Decreased serum bilirubin concentrations, false-positive phentolamine test, decreased response to metyrapone and impaired absorption of radioactive cyanocobalamin.

 

Adverse Reactions

CV: Bradycardia; hypotension; syncope. CNS: Drowsiness; agitation; confusion; headache; hyperkinesia; ataxia; CNS depression; paradoxical excitement; nightmares; psychiatric disturbances; hallucinations; insomnia; dizziness. GI: Nausea; vomiting; constipation. HEPA: Liver damage. HEMA: Blood dyscrasias (eg, agranulocytosis, thrombocytopenia). RESP: Hypoventilation; apnea; laryngospasm; bronchospasm. OTHER: Hypersensitivity reactions (eg, angioedema, rashes, exfoliative dermatitis); fever; injection site reactions (eg, local pain, thrombophlebitis).

 

Precautions

Pregnancy: Category D. Lactation: Excreted in breast milk. Children: May respond with excitement rather than depression. Elderly patients: More sensitive to drug effects; dosage reduction is required. Dependence: Tolerance or psychological and physical dependence may occur with continued use. IV administration: Do not exceed maximum IV rate; respiratory depression, apnea and hypotension may result. Parenteral solutions are highly alkaline; extravasation may cause tissue damage and necrosis. Inadvertent intra-arterial injection may lead to arterial spasm, thrombosis, and gangrene. Renal or hepatic impairment: Use drug with caution; dosage reduction may be required. Seizure disorders: Status epilepticus may result from abrupt discontinuation.

PATIENT CARE CONSIDERATIONS

 

Administration/Storage

• Give IM injections deeply into large muscle. Do not exceed maximum IM dose of 500 mg or 5 ml of volume (regardless of concentration).
• For IV administration, inject into large vein; do not exceed maximum IV rate of 50 mg/min, do not administer into artery and do not allow perivascular extravasation.
• Administer with caution to patients with history of substance abuse.
• Do not use as sleep aid for > 2 wk.
• Store parenteral form at room temperature. Do not use if discolored or if precipitate forms.
• Store suppositories in refrigerator. Do not divide.

 

Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note presence of liver disease, respiratory disease, and porphyria.
• Observe for common side effects such as sedation or dizziness and report to physician.
• With prolonged therapy monitor lab test results for liver, renal, and hematopoietic functions.
• Monitor patient carefully during IV use for potential respiratory depression.
• Assess infants of lactating mothers and report drowsiness to physician.
• In children, monitor for possible paradoxical response of increased agitation and report to physician.
• Notify physician of the following signs of barbiturate intoxication: Unsteady gait, slurred speech, confusion or irritability.
• Watch for behavior indicative of drug dependency such as inordinate requests for more medication or need to refill prescription early.

OVERDOSAGE: SIGNS & SYMPTOMS   CNS and respiratory depression, Cheyne-Stokes respiration, areflexia, constriction of pupils, oliguria, tachycardia, hypotension, lowered body temperature, coma, apnea, circulatory collapse, respiratory arrest, death

 

Patient/Family Education

• Warn patient that medication may be habit forming and for this reason it is important to take medicine as directed. Taking too little or too much can have serious complications.
• Instruct patient to report the following symptoms to physician: Nausea, vomiting, drowsiness, dizziness, fever, sore throat, mouth sores, easy bleeding, bruising, skin irritation, or exaggerated sunburn.
• Caution patient to avoid intake of alcoholic beverages or other CNS depressants.
• Advise patient that drug may cause drowsiness, and to use caution while driving or performing other tasks requiring mental alertness.

Drug Dose ::

(pen-toe-BAR-bih-tahl SO-dee-uhm)

Nembutal Sodium,  Nova Rectal

Class: Sedative and hypnotic/Barbiturate/Short-acting/Anticonvulsant

 

Action Depresses sensory cortex, decreases motor activity, alters cerebellar function and produces drowsiness, sedation and hypnosis.

 

Indications Sedation; short-term treatment of insomnia; preanesthesia; emergency control of convulsions (parenteral form).

 

Contraindications Hypersensitivity to barbiturates; manifest or latent porphyria.

 

Route/Dosage

Insomnia

ADULTS: PO/IV 100 mg (maximum IV rate 50 mg/min). IM/PR 120 to 200 mg (maximum IM dose 500 mg or 5 ml volume regardless of concentration).

Sedation

ADULTS: PO/PR 20 to 30 mg bid to qid. CHILDREN: PO/IM 2 to 6 mg/kg (maximum 100 mg). IV 50 mg.

Convulsions

ADULTS: IV Use minimum dose to avoid compounding depression. Administer slowly to allow time for drug to penetrate the blood-brain barrier. Do not exceed 50 mg/min.

Pediatric Patients Unable to Take Orally or by Injection

CHILDREN 12 to 14 YR (36.4 to 50 KG): PR 60 or 120 mg. CHILDREN 5 to 12 YR (18.2 to 36.4 KG) PR 60 mg. CHILDREN 1 to 4 YR (9 to 18.2 KG): PR 30 or 60 mg. CHILDREN 2 mo to 1 YR (4.5 to 9 KG): PR 30 mg.

 

Interactions

Alcohol, CNS depressants: May produce additive depressant effects. Anticoagulants, beta-blockers, calcium-channel blockers (eg, nifedipine, verapamil), theophylline: Activity of these drugs may be reduced. Anticonvulsants: Serum concentrations of carbamazepine, valproic acid and succinimides may be reduced. Valproic acid may increase barbiturate serum levels. Corticosteroids: Effectiveness may be reduced. Estrogen, estrogen-containing oral contraceptives: May cause decreased contraceptive and estrogen effect. Griseofulvin: Decreased griseofulvin levels.

 

Lab Test Interferences Decreased serum bilirubin concentrations, false-positive phentolamine test, decreased response to metyrapone and impaired absorption of radioactive cyanocobalamin.

 

Adverse Reactions

CV: Bradycardia; hypotension; syncope. CNS: Drowsiness; agitation; confusion; headache; hyperkinesia; ataxia; CNS depression; paradoxical excitement; nightmares; psychiatric disturbances; hallucinations; insomnia; dizziness. GI: Nausea; vomiting; constipation. HEPA: Liver damage. HEMA: Blood dyscrasias (eg, agranulocytosis, thrombocytopenia). RESP: Hypoventilation; apnea; laryngospasm; bronchospasm. OTHER: Hypersensitivity reactions (eg, angioedema, rashes, exfoliative dermatitis); fever; injection site reactions (eg, local pain, thrombophlebitis).

 

Precautions

Pregnancy: Category D. Lactation: Excreted in breast milk. Children: May respond with excitement rather than depression. Elderly patients: More sensitive to drug effects; dosage reduction is required. Dependence: Tolerance or psychological and physical dependence may occur with continued use. IV administration: Do not exceed maximum IV rate; respiratory depression, apnea and hypotension may result. Parenteral solutions are highly alkaline; extravasation may cause tissue damage and necrosis. Inadvertent intra-arterial injection may lead to arterial spasm, thrombosis, and gangrene. Renal or hepatic impairment: Use drug with caution; dosage reduction may be required. Seizure disorders: Status epilepticus may result from abrupt discontinuation.

PATIENT CARE CONSIDERATIONS

 

Administration/Storage

• Give IM injections deeply into large muscle. Do not exceed maximum IM dose of 500 mg or 5 ml of volume (regardless of concentration).
• For IV administration, inject into large vein; do not exceed maximum IV rate of 50 mg/min, do not administer into artery and do not allow perivascular extravasation.
• Administer with caution to patients with history of substance abuse.
• Do not use as sleep aid for > 2 wk.
• Store parenteral form at room temperature. Do not use if discolored or if precipitate forms.
• Store suppositories in refrigerator. Do not divide.

 

Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note presence of liver disease, respiratory disease, and porphyria.
• Observe for common side effects such as sedation or dizziness and report to physician.
• With prolonged therapy monitor lab test results for liver, renal, and hematopoietic functions.
• Monitor patient carefully during IV use for potential respiratory depression.
• Assess infants of lactating mothers and report drowsiness to physician.
• In children, monitor for possible paradoxical response of increased agitation and report to physician.
• Notify physician of the following signs of barbiturate intoxication: Unsteady gait, slurred speech, confusion or irritability.
• Watch for behavior indicative of drug dependency such as inordinate requests for more medication or need to refill prescription early.

OVERDOSAGE: SIGNS & SYMPTOMS   CNS and respiratory depression, Cheyne-Stokes respiration, areflexia, constriction of pupils, oliguria, tachycardia, hypotension, lowered body temperature, coma, apnea, circulatory collapse, respiratory arrest, death

 

Patient/Family Education

• Warn patient that medication may be habit forming and for this reason it is important to take medicine as directed. Taking too little or too much can have serious complications.
• Instruct patient to report the following symptoms to physician: Nausea, vomiting, drowsiness, dizziness, fever, sore throat, mouth sores, easy bleeding, bruising, skin irritation, or exaggerated sunburn.
• Caution patient to avoid intake of alcoholic beverages or other CNS depressants.
• Advise patient that drug may cause drowsiness, and to use caution while driving or performing other tasks requiring mental alertness.

Contraindication ::

(pen-toe-BAR-bih-tahl SO-dee-uhm)

Nembutal Sodium,  Nova Rectal

Class: Sedative and hypnotic/Barbiturate/Short-acting/Anticonvulsant

 

Action Depresses sensory cortex, decreases motor activity, alters cerebellar function and produces drowsiness, sedation and hypnosis.

 

Indications Sedation; short-term treatment of insomnia; preanesthesia; emergency control of convulsions (parenteral form).

 

Contraindications Hypersensitivity to barbiturates; manifest or latent porphyria.

 

Route/Dosage

Insomnia

ADULTS: PO/IV 100 mg (maximum IV rate 50 mg/min). IM/PR 120 to 200 mg (maximum IM dose 500 mg or 5 ml volume regardless of concentration).

Sedation

ADULTS: PO/PR 20 to 30 mg bid to qid. CHILDREN: PO/IM 2 to 6 mg/kg (maximum 100 mg). IV 50 mg.

Convulsions

ADULTS: IV Use minimum dose to avoid compounding depression. Administer slowly to allow time for drug to penetrate the blood-brain barrier. Do not exceed 50 mg/min.

Pediatric Patients Unable to Take Orally or by Injection

CHILDREN 12 to 14 YR (36.4 to 50 KG): PR 60 or 120 mg. CHILDREN 5 to 12 YR (18.2 to 36.4 KG) PR 60 mg. CHILDREN 1 to 4 YR (9 to 18.2 KG): PR 30 or 60 mg. CHILDREN 2 mo to 1 YR (4.5 to 9 KG): PR 30 mg.

 

Interactions

Alcohol, CNS depressants: May produce additive depressant effects. Anticoagulants, beta-blockers, calcium-channel blockers (eg, nifedipine, verapamil), theophylline: Activity of these drugs may be reduced. Anticonvulsants: Serum concentrations of carbamazepine, valproic acid and succinimides may be reduced. Valproic acid may increase barbiturate serum levels. Corticosteroids: Effectiveness may be reduced. Estrogen, estrogen-containing oral contraceptives: May cause decreased contraceptive and estrogen effect. Griseofulvin: Decreased griseofulvin levels.

 

Lab Test Interferences Decreased serum bilirubin concentrations, false-positive phentolamine test, decreased response to metyrapone and impaired absorption of radioactive cyanocobalamin.

 

Adverse Reactions

CV: Bradycardia; hypotension; syncope. CNS: Drowsiness; agitation; confusion; headache; hyperkinesia; ataxia; CNS depression; paradoxical excitement; nightmares; psychiatric disturbances; hallucinations; insomnia; dizziness. GI: Nausea; vomiting; constipation. HEPA: Liver damage. HEMA: Blood dyscrasias (eg, agranulocytosis, thrombocytopenia). RESP: Hypoventilation; apnea; laryngospasm; bronchospasm. OTHER: Hypersensitivity reactions (eg, angioedema, rashes, exfoliative dermatitis); fever; injection site reactions (eg, local pain, thrombophlebitis).

 

Precautions

Pregnancy: Category D. Lactation: Excreted in breast milk. Children: May respond with excitement rather than depression. Elderly patients: More sensitive to drug effects; dosage reduction is required. Dependence: Tolerance or psychological and physical dependence may occur with continued use. IV administration: Do not exceed maximum IV rate; respiratory depression, apnea and hypotension may result. Parenteral solutions are highly alkaline; extravasation may cause tissue damage and necrosis. Inadvertent intra-arterial injection may lead to arterial spasm, thrombosis, and gangrene. Renal or hepatic impairment: Use drug with caution; dosage reduction may be required. Seizure disorders: Status epilepticus may result from abrupt discontinuation.

PATIENT CARE CONSIDERATIONS

 

Administration/Storage

• Give IM injections deeply into large muscle. Do not exceed maximum IM dose of 500 mg or 5 ml of volume (regardless of concentration).
• For IV administration, inject into large vein; do not exceed maximum IV rate of 50 mg/min, do not administer into artery and do not allow perivascular extravasation.
• Administer with caution to patients with history of substance abuse.
• Do not use as sleep aid for > 2 wk.
• Store parenteral form at room temperature. Do not use if discolored or if precipitate forms.
• Store suppositories in refrigerator. Do not divide.

 

Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note presence of liver disease, respiratory disease, and porphyria.
• Observe for common side effects such as sedation or dizziness and report to physician.
• With prolonged therapy monitor lab test results for liver, renal, and hematopoietic functions.
• Monitor patient carefully during IV use for potential respiratory depression.
• Assess infants of lactating mothers and report drowsiness to physician.
• In children, monitor for possible paradoxical response of increased agitation and report to physician.
• Notify physician of the following signs of barbiturate intoxication: Unsteady gait, slurred speech, confusion or irritability.
• Watch for behavior indicative of drug dependency such as inordinate requests for more medication or need to refill prescription early.

OVERDOSAGE: SIGNS & SYMPTOMS   CNS and respiratory depression, Cheyne-Stokes respiration, areflexia, constriction of pupils, oliguria, tachycardia, hypotension, lowered body temperature, coma, apnea, circulatory collapse, respiratory arrest, death

 

Patient/Family Education

• Warn patient that medication may be habit forming and for this reason it is important to take medicine as directed. Taking too little or too much can have serious complications.
• Instruct patient to report the following symptoms to physician: Nausea, vomiting, drowsiness, dizziness, fever, sore throat, mouth sores, easy bleeding, bruising, skin irritation, or exaggerated sunburn.
• Caution patient to avoid intake of alcoholic beverages or other CNS depressants.
• Advise patient that drug may cause drowsiness, and to use caution while driving or performing other tasks requiring mental alertness.

Drug Precautions ::

(pen-toe-BAR-bih-tahl SO-dee-uhm)

Nembutal Sodium,  Nova Rectal

Class: Sedative and hypnotic/Barbiturate/Short-acting/Anticonvulsant

 

Action Depresses sensory cortex, decreases motor activity, alters cerebellar function and produces drowsiness, sedation and hypnosis.

 

Indications Sedation; short-term treatment of insomnia; preanesthesia; emergency control of convulsions (parenteral form).

 

Contraindications Hypersensitivity to barbiturates; manifest or latent porphyria.

 

Route/Dosage

Insomnia

ADULTS: PO/IV 100 mg (maximum IV rate 50 mg/min). IM/PR 120 to 200 mg (maximum IM dose 500 mg or 5 ml volume regardless of concentration).

Sedation

ADULTS: PO/PR 20 to 30 mg bid to qid. CHILDREN: PO/IM 2 to 6 mg/kg (maximum 100 mg). IV 50 mg.

Convulsions

ADULTS: IV Use minimum dose to avoid compounding depression. Administer slowly to allow time for drug to penetrate the blood-brain barrier. Do not exceed 50 mg/min.

Pediatric Patients Unable to Take Orally or by Injection

CHILDREN 12 to 14 YR (36.4 to 50 KG): PR 60 or 120 mg. CHILDREN 5 to 12 YR (18.2 to 36.4 KG) PR 60 mg. CHILDREN 1 to 4 YR (9 to 18.2 KG): PR 30 or 60 mg. CHILDREN 2 mo to 1 YR (4.5 to 9 KG): PR 30 mg.

 

Interactions

Alcohol, CNS depressants: May produce additive depressant effects. Anticoagulants, beta-blockers, calcium-channel blockers (eg, nifedipine, verapamil), theophylline: Activity of these drugs may be reduced. Anticonvulsants: Serum concentrations of carbamazepine, valproic acid and succinimides may be reduced. Valproic acid may increase barbiturate serum levels. Corticosteroids: Effectiveness may be reduced. Estrogen, estrogen-containing oral contraceptives: May cause decreased contraceptive and estrogen effect. Griseofulvin: Decreased griseofulvin levels.

 

Lab Test Interferences Decreased serum bilirubin concentrations, false-positive phentolamine test, decreased response to metyrapone and impaired absorption of radioactive cyanocobalamin.

 

Adverse Reactions

CV: Bradycardia; hypotension; syncope. CNS: Drowsiness; agitation; confusion; headache; hyperkinesia; ataxia; CNS depression; paradoxical excitement; nightmares; psychiatric disturbances; hallucinations; insomnia; dizziness. GI: Nausea; vomiting; constipation. HEPA: Liver damage. HEMA: Blood dyscrasias (eg, agranulocytosis, thrombocytopenia). RESP: Hypoventilation; apnea; laryngospasm; bronchospasm. OTHER: Hypersensitivity reactions (eg, angioedema, rashes, exfoliative dermatitis); fever; injection site reactions (eg, local pain, thrombophlebitis).

 

Precautions

Pregnancy: Category D. Lactation: Excreted in breast milk. Children: May respond with excitement rather than depression. Elderly patients: More sensitive to drug effects; dosage reduction is required. Dependence: Tolerance or psychological and physical dependence may occur with continued use. IV administration: Do not exceed maximum IV rate; respiratory depression, apnea and hypotension may result. Parenteral solutions are highly alkaline; extravasation may cause tissue damage and necrosis. Inadvertent intra-arterial injection may lead to arterial spasm, thrombosis, and gangrene. Renal or hepatic impairment: Use drug with caution; dosage reduction may be required. Seizure disorders: Status epilepticus may result from abrupt discontinuation.

PATIENT CARE CONSIDERATIONS

 

Administration/Storage

• Give IM injections deeply into large muscle. Do not exceed maximum IM dose of 500 mg or 5 ml of volume (regardless of concentration).
• For IV administration, inject into large vein; do not exceed maximum IV rate of 50 mg/min, do not administer into artery and do not allow perivascular extravasation.
• Administer with caution to patients with history of substance abuse.
• Do not use as sleep aid for > 2 wk.
• Store parenteral form at room temperature. Do not use if discolored or if precipitate forms.
• Store suppositories in refrigerator. Do not divide.

 

Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note presence of liver disease, respiratory disease, and porphyria.
• Observe for common side effects such as sedation or dizziness and report to physician.
• With prolonged therapy monitor lab test results for liver, renal, and hematopoietic functions.
• Monitor patient carefully during IV use for potential respiratory depression.
• Assess infants of lactating mothers and report drowsiness to physician.
• In children, monitor for possible paradoxical response of increased agitation and report to physician.
• Notify physician of the following signs of barbiturate intoxication: Unsteady gait, slurred speech, confusion or irritability.
• Watch for behavior indicative of drug dependency such as inordinate requests for more medication or need to refill prescription early.

OVERDOSAGE: SIGNS & SYMPTOMS   CNS and respiratory depression, Cheyne-Stokes respiration, areflexia, constriction of pupils, oliguria, tachycardia, hypotension, lowered body temperature, coma, apnea, circulatory collapse, respiratory arrest, death

 

Patient/Family Education

• Warn patient that medication may be habit forming and for this reason it is important to take medicine as directed. Taking too little or too much can have serious complications.
• Instruct patient to report the following symptoms to physician: Nausea, vomiting, drowsiness, dizziness, fever, sore throat, mouth sores, easy bleeding, bruising, skin irritation, or exaggerated sunburn.
• Caution patient to avoid intake of alcoholic beverages or other CNS depressants.
• Advise patient that drug may cause drowsiness, and to use caution while driving or performing other tasks requiring mental alertness.

Drug Side Effects ::

(pen-toe-BAR-bih-tahl SO-dee-uhm)

Nembutal Sodium,  Nova Rectal

Class: Sedative and hypnotic/Barbiturate/Short-acting/Anticonvulsant

 

Action Depresses sensory cortex, decreases motor activity, alters cerebellar function and produces drowsiness, sedation and hypnosis.

 

Indications Sedation; short-term treatment of insomnia; preanesthesia; emergency control of convulsions (parenteral form).

 

Contraindications Hypersensitivity to barbiturates; manifest or latent porphyria.

 

Route/Dosage

Insomnia

ADULTS: PO/IV 100 mg (maximum IV rate 50 mg/min). IM/PR 120 to 200 mg (maximum IM dose 500 mg or 5 ml volume regardless of concentration).

Sedation

ADULTS: PO/PR 20 to 30 mg bid to qid. CHILDREN: PO/IM 2 to 6 mg/kg (maximum 100 mg). IV 50 mg.

Convulsions

ADULTS: IV Use minimum dose to avoid compounding depression. Administer slowly to allow time for drug to penetrate the blood-brain barrier. Do not exceed 50 mg/min.

Pediatric Patients Unable to Take Orally or by Injection

CHILDREN 12 to 14 YR (36.4 to 50 KG): PR 60 or 120 mg. CHILDREN 5 to 12 YR (18.2 to 36.4 KG) PR 60 mg. CHILDREN 1 to 4 YR (9 to 18.2 KG): PR 30 or 60 mg. CHILDREN 2 mo to 1 YR (4.5 to 9 KG): PR 30 mg.

 

Interactions

Alcohol, CNS depressants: May produce additive depressant effects. Anticoagulants, beta-blockers, calcium-channel blockers (eg, nifedipine, verapamil), theophylline: Activity of these drugs may be reduced. Anticonvulsants: Serum concentrations of carbamazepine, valproic acid and succinimides may be reduced. Valproic acid may increase barbiturate serum levels. Corticosteroids: Effectiveness may be reduced. Estrogen, estrogen-containing oral contraceptives: May cause decreased contraceptive and estrogen effect. Griseofulvin: Decreased griseofulvin levels.

 

Lab Test Interferences Decreased serum bilirubin concentrations, false-positive phentolamine test, decreased response to metyrapone and impaired absorption of radioactive cyanocobalamin.

 

Adverse Reactions

CV: Bradycardia; hypotension; syncope. CNS: Drowsiness; agitation; confusion; headache; hyperkinesia; ataxia; CNS depression; paradoxical excitement; nightmares; psychiatric disturbances; hallucinations; insomnia; dizziness. GI: Nausea; vomiting; constipation. HEPA: Liver damage. HEMA: Blood dyscrasias (eg, agranulocytosis, thrombocytopenia). RESP: Hypoventilation; apnea; laryngospasm; bronchospasm. OTHER: Hypersensitivity reactions (eg, angioedema, rashes, exfoliative dermatitis); fever; injection site reactions (eg, local pain, thrombophlebitis).

 

Precautions

Pregnancy: Category D. Lactation: Excreted in breast milk. Children: May respond with excitement rather than depression. Elderly patients: More sensitive to drug effects; dosage reduction is required. Dependence: Tolerance or psychological and physical dependence may occur with continued use. IV administration: Do not exceed maximum IV rate; respiratory depression, apnea and hypotension may result. Parenteral solutions are highly alkaline; extravasation may cause tissue damage and necrosis. Inadvertent intra-arterial injection may lead to arterial spasm, thrombosis, and gangrene. Renal or hepatic impairment: Use drug with caution; dosage reduction may be required. Seizure disorders: Status epilepticus may result from abrupt discontinuation.

PATIENT CARE CONSIDERATIONS

 

Administration/Storage

• Give IM injections deeply into large muscle. Do not exceed maximum IM dose of 500 mg or 5 ml of volume (regardless of concentration).
• For IV administration, inject into large vein; do not exceed maximum IV rate of 50 mg/min, do not administer into artery and do not allow perivascular extravasation.
• Administer with caution to patients with history of substance abuse.
• Do not use as sleep aid for > 2 wk.
• Store parenteral form at room temperature. Do not use if discolored or if precipitate forms.
• Store suppositories in refrigerator. Do not divide.

 

Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note presence of liver disease, respiratory disease, and porphyria.
• Observe for common side effects such as sedation or dizziness and report to physician.
• With prolonged therapy monitor lab test results for liver, renal, and hematopoietic functions.
• Monitor patient carefully during IV use for potential respiratory depression.
• Assess infants of lactating mothers and report drowsiness to physician.
• In children, monitor for possible paradoxical response of increased agitation and report to physician.
• Notify physician of the following signs of barbiturate intoxication: Unsteady gait, slurred speech, confusion or irritability.
• Watch for behavior indicative of drug dependency such as inordinate requests for more medication or need to refill prescription early.

OVERDOSAGE: SIGNS & SYMPTOMS   CNS and respiratory depression, Cheyne-Stokes respiration, areflexia, constriction of pupils, oliguria, tachycardia, hypotension, lowered body temperature, coma, apnea, circulatory collapse, respiratory arrest, death

 

Patient/Family Education

• Warn patient that medication may be habit forming and for this reason it is important to take medicine as directed. Taking too little or too much can have serious complications.
• Instruct patient to report the following symptoms to physician: Nausea, vomiting, drowsiness, dizziness, fever, sore throat, mouth sores, easy bleeding, bruising, skin irritation, or exaggerated sunburn.
• Caution patient to avoid intake of alcoholic beverages or other CNS depressants.
• Advise patient that drug may cause drowsiness, and to use caution while driving or performing other tasks requiring mental alertness.

Drug Mode of Action ::  

(pen-toe-BAR-bih-tahl SO-dee-uhm)

Nembutal Sodium,  Nova Rectal

Class: Sedative and hypnotic/Barbiturate/Short-acting/Anticonvulsant

 

Action Depresses sensory cortex, decreases motor activity, alters cerebellar function and produces drowsiness, sedation and hypnosis.