Amobarbital

Amobarbital is a barbiturate, used as a hypnotic and sedative. Amobarbital is now rarely recommended because of its adverse side effects and dependence.

Amobarbital is primarily indicated in condition like Sleep induction.

Amobarbital is contraindicated in conditions like Pregnancy, Porphyria, Breast feeding, Heterozygous familial hypercholesterolemia, Hyperlipidemias, see instruction, Central retinal venous/arterial thrombosis.

The symptomatic adverse reactions produced by Amobarbital are more or less tolerable and if they become severe, they can be treated symptomatically, these include Dizziness, Headache, Ataxia, Confusion, Respiratory depression, Hypersensitivity reactions, Hangover with drowsiness, Paradoxical excitement, Precede sleep, Somnolence.

Concerns related to adverse effects: • CNS depression: May cause CNS depression, which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving). • Paradoxical responses: May cause paradoxical excitement, particularly in patients with acute or chronic pain. Disease-related concerns: • Depression: Use with caution, if at all, in patients with depression or suicidal tendencies. • Drug abuse: Use with caution, if at all, in patients with a history of drug abuse or acute alcoholism; potential for drug dependency exists. Tolerance, psychological and physical dependence may occur with prolonged use. • Hepatic impairment: Use with caution in patients with hepatic impairment, decreased dosage may be needed; contraindicated in severe impairment. Do not administer to patients showing premonitory signs of hepatic coma. • Hypoadrenalism: Use with caution in patients with borderline hypoadrenal function; even if it is of pituitary or of primary adrenal origin. Systemic effects of exogenous and endogenous corticosteroids may be diminished by amobarbital. • Renal impairment: Use with caution in patients with renal impairment; decreased dosage may be needed. • Respiratory disease: Use with caution in patients with respiratory disease; may cause respiratory depression. Special populations: • Debilitated patient: Use with caution in debilitated patients; may react to barbiturates with marked excitement, depression, and confusion; reduced dosages are recommended. • Pediatric: Barbiturates repeatedly produce excitement rather than depression in some patients, particularly children. Dosage form specific issues: • Alkaline solution: Solution for injection is highly alkaline and extravasation may cause local tissue damage with subsequent necrosis. Other warnings/precautions: • Appropriate use: When used as a hypnotic for the treatment of insomnia, effectiveness is limited to ≤2 weeks. • Administration: Rapid IV administration may cause respiratory depression, apnea, laryngospasm, or vasodilation with a fall in blood pressure; avoid perivascular extravasation or intra-arterial injection; discontinue if patient complains of pain in the limb. Restrict use of IV administration to conditions in which other routes are not feasible, if patient is unconscious (eg, cerebral hemorrhage, eclampsia, or status epilepticus) or patient resists (eg, delirium), or because prompt action is imperative. • Withdrawal: Abrupt cessation may precipitate withdrawal, including delirium and convulsions (some fatal); withdraw gradually.

Concerns related to adverse effects: • CNS depression: May cause CNS depression, which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving). • Paradoxical responses: May cause paradoxical excitement, particularly in patients with acute or chronic pain. Disease-related concerns: • Depression: Use with caution, if at all, in patients with depression or suicidal tendencies. • Drug abuse: Use with caution, if at all, in patients with a history of drug abuse or acute alcoholism; potential for drug dependency exists. Tolerance, psychological and physical dependence may occur with prolonged use. • Hepatic impairment: Use with caution in patients with hepatic impairment, decreased dosage may be needed; contraindicated in severe impairment. Do not administer to patients showing premonitory signs of hepatic coma. • Hypoadrenalism: Use with caution in patients with borderline hypoadrenal function; even if it is of pituitary or of primary adrenal origin. Systemic effects of exogenous and endogenous corticosteroids may be diminished by amobarbital. • Renal impairment: Use with caution in patients with renal impairment; decreased dosage may be needed. • Respiratory disease: Use with caution in patients with respiratory disease; may cause respiratory depression. Special populations: • Debilitated patient: Use with caution in debilitated patients; may react to barbiturates with marked excitement, depression, and confusion; reduced dosages are recommended. • Pediatric: Barbiturates repeatedly produce excitement rather than depression in some patients, particularly children. Dosage form specific issues: • Alkaline solution: Solution for injection is highly alkaline and extravasation may cause local tissue damage with subsequent necrosis. Other warnings/precautions: • Appropriate use: When used as a hypnotic for the treatment of insomnia, effectiveness is limited to ≤2 weeks. • Administration: Rapid IV administration may cause respiratory depression, apnea, laryngospasm, or vasodilation with a fall in blood pressure; avoid perivascular extravasation or intra-arterial injection; discontinue if patient complains of pain in the limb. Restrict use of IV administration to conditions in which other routes are not feasible, if patient is unconscious (eg, cerebral hemorrhage, eclampsia, or status epilepticus) or patient resists (eg, delirium), or because prompt action is imperative. • Withdrawal: Abrupt cessation may precipitate withdrawal, including delirium and convulsions (some fatal); withdraw gradually.

200 mg (200 (200)) As recommended. PO — This dose is for sedation before surgery. Should be taken 1 to 2 hours before surgery.. 200 to 400 mg (300 (300)) As recommended. PO — This dose is for sedation during labour. To be taken every one to three hours if needed. However, the total dose is usually not more than 1000 mg. 30 to 50 mg (40 (40)) As recommended. IM/IV — This dose is for day time sedation. To be taken 2-3 times a day. 50 to 300 mg (180 (175)) As recommended. PO — This dose is for day time sedation. Should be taken in smaller doses during the day. 65 to 200 mg (130 (132.5)) As recommended. IV/IM — This dose is for trouble in sleeping. Should be injected into a muscle or vein. 65 to 200 mg (130 (132.5)) As recommended. PO — This dose is for trouble in sleeping. Should be taken at bed time. 65 to 500 mg/dose (280 (282.5)) As recommended. IV — This dose is for control of seizures. Scraped Dose — Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Solution Reconstituted, Injection, as sodium: Amytal Sodium: 500 mg (1 ea)

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No neonatal dosage information is recorded for this medicine yet.

Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Monitor therapy Alizapride: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Azelastine (Nasal): May enhance the CNS depressant effect of CNS Depressants. Avoid combination Beta-Blockers: Barbiturates may decrease the serum concentration of Beta-Blockers. Monitor therapy Blonanserin: CNS Depressants may enhance the CNS depressant effect of Blonanserin. Management: Use caution if coadministering blonanserin and CNS depressants; dose reduction of the other CNS depressant may be required. Strong CNS depressants should not be coadministered with blonanserin. Consider therapy modification Blood Pressure Lowering Agents: Barbiturates may enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Brexanolone: CNS Depressants may enhance the CNS depressant effect of Brexanolone. Monitor therapy Brimonidine (Topical): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Bromopride: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Bromperidol: May enhance the CNS depressant effect of CNS Depressants. Avoid combination Buprenorphine: CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Consider therapy modification Calcium Channel Blockers: Barbiturates may increase the metabolism of Calcium Channel Blockers. Management: Monitor for decreased therapeutic effects of calcium channel blockers with concomitant barbiturate therapy. Calcium channel blocker dose adjustments may be necessary. Nimodipine Canadian labeling contraindicates concomitant use with phenobarbital. Monitor therapy Cannabidiol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Cannabis: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Chloramphenicol (Systemic): May decrease the metabolism of Barbiturates. Barbiturates may increase the metabolism of Chloramphenicol (Systemic). Monitor therapy Chlormethiazole: May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Consider therapy modification Chlorphenesin Carbamate: May enhance the adverse/toxic effect of CNS Depressants. Monitor therapy CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants. Monitor therapy Dimethindene (Topical): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Doxycycline: Barbiturates may decrease the serum concentration of Doxycycline. Monitor therapy Doxylamine: May enhance the CNS depressant effect of CNS Depressants. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended. Monitor therapy Dronabinol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Droperidol: May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Consider therapy modification Esketamine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Estrogen Derivatives (Contraceptive): Barbiturates may diminish the therapeutic effect of Estrogen Derivatives (Contraceptive). Contraceptive failure is possible. Management: Use of a non-hormonal contraceptive is recommended. Breakthrough bleeding, though an important sign regarding the diminished effect of oral contraceptives, might not be present in spite of the occurrence of an interaction. Consider therapy modification Felbamate: May increase the serum concentration of Barbiturates. Barbiturates may decrease the serum concentration of Felbamate. Management: Monitor for elevated barbiturate concentrations/toxicity if felbamate is initiated/dose increased, or reduced concentrations/effects if felbamate is discontinued/dose decreased. Refer to phenobarbital dosing guidelines for patients receiving that agent. Monitor therapy Flunitrazepam: CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. Management: Reduce the dose of CNS depressants when combined with flunitrazepam and monitor patients for evidence of CNS depression (eg, sedation, respiratory depression). Use non-CNS depressant alternatives when available. Consider therapy modification Griseofulvin: Barbiturates may decrease the serum concentration of Griseofulvin. Monitor therapy Hemin: Barbiturates may diminish the therapeutic effect of Hemin. Avoid combination HydrOXYzine: May enhance the CNS depressant effect of Barbiturates. Management: Consider a decrease in the barbiturate dose, as appropriate, when used together with hydroxyzine. With concurrent use, monitor patients closely for excessive response to the combination. Consider therapy modification Kava Kava: May enhance the adverse/toxic effect of CNS Depressants. Monitor therapy Lemborexant: May enhance the CNS depressant effect of CNS Depressants. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary. Consider therapy modification Lisuride: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Lofexidine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Magnesium Sulfate: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Methotrimeprazine: CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce the usual dose of CNS depressants by 50% if starting methotrimeprazine until the dose of methotrimeprazine is stable. Monitor patient closely for evidence of CNS depression. Consider therapy modification Methoxyflurane: Barbiturates may enhance the nephrotoxic effect of Methoxyflurane. Barbiturates may increase the metabolism of Methoxyflurane. Avoid combination Metoclopramide: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy MetyroSINE: CNS Depressants may enhance the sedative effect of MetyroSINE. Monitor therapy Mianserin: May enhance the CNS depressant effect of Barbiturates. Mianserin may diminish the therapeutic effect of Barbiturates. Barbiturates may decrease the serum concentration of Mianserin. Avoid combination Minocycline (Systemic): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Multivitamins/Minerals (with ADEK, Folate, Iron): May decrease the serum concentration of Barbiturates. Monitor therapy Nabilone: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Opioid Agonists: CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification Orphenadrine: CNS Depressants may enhance the CNS depressant effect of Orphenadrine. Avoid combination Oxomemazine: May enhance the CNS depressant effect of CNS Depressants. Avoid combination Oxybate Salt Products: CNS Depressants may enhance the CNS depressant effect of Oxybate Salt Products. Management: Consider alternatives to this combination when possible. If combined, dose reduction or discontinuation of one or more CNS depressants (including the oxybate salt product) should be considered. Interrupt oxybate salt treatment during short-term opioid use Consider therapy modification OxyCODONE: CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification Paraldehyde: CNS Depressants may enhance the CNS depressant effect of Paraldehyde. Avoid combination Perampanel: May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination. Consider therapy modification Piribedil: CNS Depressants may enhance the CNS depressant effect of Piribedil. Monitor therapy Pramipexole: CNS Depressants may enhance the sedative effect of Pramipexole. Monitor therapy Primidone: May enhance the adverse/toxic effect of Barbiturates. Primidone is converted to phenobarbital, and thus becomes additive with existing barbiturate therapy. Monitor therapy Progestins (Contraceptive): Barbiturates may diminish the therapeutic effect of Progestins (Contraceptive). Contraceptive failure is possible. Management: Use of alternative, nonhormonal contraceptives is recommended. When using levonorgestrel as emergency contraception, non-US guidelines suggest doubling the dose of levonorgestrel to 3 mg in women who have used enzyme inducing drugs in the past 4 weeks. Consider therapy modification Propacetamol: Barbiturates may increase the metabolism of Propacetamol. This may 1) diminish the desired effects of propacetamol; and 2) increase the risk of liver damage. Monitor therapy Pyridoxine: May increase the metabolism of Barbiturates. Apparent in high pyridoxine doses (eg, 200 mg/day) Monitor therapy Rifamycin Derivatives: May increase the metabolism of Barbiturates. Monitor therapy ROPINIRole: CNS Depressants may enhance the sedative effect of ROPINIRole. Monitor therapy Rotigotine: CNS Depressants may enhance the sedative effect of Rotigotine. Monitor therapy Rufinamide: May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced. Monitor therapy Somatostatin Acetate: May enhance the adverse/toxic effect of Barbiturates. Specifically, Somatostatin Acetate may enhance or prolong Barbiturate effects, including sedative effects. Avoid combination Suvorexant: CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Consider therapy modification Teniposide: Barbiturates may decrease the serum concentration of Teniposide. Management: Consider alternatives to combined treatment with barbiturates and teniposide due to the potential for decreased teniposide concentrations. If the combination cannot be avoided, monitor teniposide response closely. Consider therapy modification Tetrahydrocannabinol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Tetrahydrocannabinol and Cannabidiol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Thalidomide: CNS Depressants may enhance the CNS depressant effect of Thalidomide. Avoid combination Theophylline Derivatives: Barbiturates may decrease the serum concentration of Theophylline Derivatives. Monitor therapy Tricyclic Antidepressants: Barbiturates may increase the metabolism of Tricyclic Antidepressants. Management: Monitor for decreased efficacy of tricyclic antidepressants if a barbiturate is initiated/dose increased, or increased effects if a barbiturate is discontinued/dose decreased. Tricyclic antidepressant dose adjustments are likely required. Consider therapy modification Trimeprazine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy Ulipristal: Barbiturates may decrease the serum concentration of Ulipristal. Avoid combination Valproate Products: May increase the serum concentration of Barbiturates. Barbiturates may decrease the serum concentration of Valproate Products. Monitor therapy Vitamin K Antagonists (eg, warfarin): Barbiturates may increase the metabolism of Vitamin K Antagonists. Management: Monitor INR more closely. Anticoagulant dose increases of 30% to 60% may be needed after a barbiturate is initiated or given at an increased dose. Anticoagulant dose decreases may be needed following barbiturate discontinuation or dose reduction. Consider therapy modification Voriconazole: Barbiturates may decrease the serum concentration of Voriconazole. Avoid combination Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Consider therapy modification

Tabs,Caps Store in a well closed container, . Protect from Sunlight and Heat.