Methohexital

BREVITAL

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What it isUltra-short-acting barbiturate that potentiates GABA-A; IV induction agent for anesthesia and brief procedures, especially ECT.

Why this oneRapid onset and recovery with less seizure suppression than propofol, so it preserves ECT seizure quality.

What limits itCauses apnea, laryngospasm, and cardiovascular depression; use only with continuous cardiorespiratory monitoring and immediate airway rescue.

FDA-approved for

induction of anesthesia (1960)

FDA label

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BOXED WARNING Use only in settings providing continuous respiratory (pulse oximetry) and cardiac monitoring, with resuscitative drugs/equipment and trained personnel immediately available; a dedicated monitor other than the proceduralist for deeply sedated patients.

FDA dosing	Population	Start	Target	Max
Induction of anesthesia / sedation	adult	Individualized by route (IV, IM, rectal, continuous drip); prepare 1% solution for intermittent IV/rectal, 0.2% for continuous IV, 5% for IM	titrated to effect	titrated to effect

Renal Undefined

Hepatic Undefined

Instructions

Follow dilution instructions exactly; freshly prepare and use promptly (stable 24 h at room temp)
Use bacteriostatic-free diluent
Do NOT use Lactated Ringer’s (incompatible)
Ensure facilities for ventilation and oxygen; observe carefully during and after use

Contraindications

Patients in whom general anesthesia is contraindicated
Latent or manifest porphyria
Known hypersensitivity to barbiturates

Cautions

Cardiorespiratory arrest may occur — continuous monitoring required
Respiratory depression/apnea, laryngospasm, bronchospasm
Circulatory/myocardial depression, hypotension
Skeletal muscle hyperactivity (twitching), seizures

Adverse reactions

Respiratory depression (incl. apnea), laryngospasm, bronchospasm, hiccups
Circulatory depression, hypotension, tachycardia, thrombophlebitis
Skeletal muscle twitching, seizures
Emergence delirium, restlessness, anxiety
Nausea, emesis, abdominal pain
Injection-site pain, anaphylaxis (rare)

Pregnancy Undefined

Lactation Undefined

⚠ BOXED WARNING

Use only where continuous respiratory and cardiac monitoring, resuscitation equipment, and airway-skilled personnel are immediately available.

Cost, est. cash$30–$300/dose

Generic entryBy 2023

Classes and tags

Clinical profile

Therapeutic safety burden4 / 4

Overdose danger4 / 4

Weight-gain liability0 / 4

Sedation liability4 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryC

Defining liabilityApnea, hypotension and loss of protective reflexes require continuous monitoring and airway capability.

Mechanism of action: Methohexital ballicule

Methohexital ballicule: receptor binding, kinetics and half-life diagram

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Memory aids: mascots and interaction avatars

Methohexital BREVITAL mascot mnemonic cartoon — **“Briefly vital Metal hexapod”**
barbs → barbiturate

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