Secobarbital
SECONAL
What it isShort-acting barbiturate; insomnia, and in some jurisdictions medical aid in dying.
Why this oneRapid, reliable sedation.
What limits itBarbiturate dependence, a narrow margin and lethal overdose. Schedule II; largely obsolete as a hypnotic.
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Insomnia (hypnotic, short-term) | Adults | 100 mg QHS | 100 mg QHS | 100 mg QHS |
| Preanesthetic | Adults | 200-300 mg 1-2 h before surgery | 200-300 mg preop | 300 mg |
| Preanesthetic | Pediatric | 2-6 mg/kg preop | 2-6 mg/kg | 100 mg |
Renal Reduce dose (impaired renal function)
Hepatic Reduce dose; contraindicated in marked liver impairment
Instructions
- Individualize dose by age, weight, condition
- Reduce dose in elderly or debilitated patients
- Withdraw gradually after prolonged use to avoid withdrawal (delirium, convulsions)
Contraindications
- History of manifest or latent porphyria
- Marked impairment of liver function
- Respiratory disease in which dyspnea or obstruction is evident
Cautions
- Habit-forming; tolerance, psychological and physical dependence
- Abrupt cessation after prolonged use may cause withdrawal (delirium, convulsions, death)
- Complex sleep behaviors (sleep-driving)
- Caution in acute or chronic pain (paradoxical excitement/masked symptoms)
- Additive CNS depression with alcohol/other CNS depressants
- Caution in mentally depressed/suicidal/history of drug abuse
Adverse reactions
- Somnolence
- Agitation
- Confusion
- Ataxia
- Hypoventilation/apnea
- Bradycardia
- Hypotension
- Nausea
- Vomiting
- Hypersensitivity reactions
Pregnancy Pregnancy Category D — can cause fetal harm; withdrawal in infants exposed in last trimester
Lactation Small amounts excreted in milk; exercise caution in nursing women
NO BOXED WARNINGS
Principal riskDependence and lethal overdose; a narrow margin
Classes and tags
Clinical profile
Mechanism of action: Secobarbital ballicule
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