Generic Name

Secobarbital Sodium

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Classification

FDA Approved Indications

• Short-term treatment of insomnia
• Sedation prior to medical procedures

Mechanism of Action

Secobarbital binds to GABA-A receptors, enhancing the inhibitory effects of gamma-aminobutyric acid (GABA), leading to sedative, hypnotic, and anticonvulsant effects.

Dosage and Administration

Adult: Typically 100-200 mg at bedtime; dosage adjusted based on response and tolerability.

Pediatric: Not generally recommended due to safety concerns.

Geriatric: Start at lower end of dosing range, monitor closely for adverse effects.

Renal Impairment: Use with caution; dosage adjustments may be necessary.

Hepatic Impairment: Use with caution; monitor for increased sedation.

Pharmacokinetics

Absorption: Rapid absorption from the gastrointestinal tract.

Distribution: Widely distributed, crosses the blood-brain barrier.

Metabolism: Metabolized in the liver, primarily via hydroxylation and conjugation.

Excretion: Excreted mainly in the urine as metabolites.

Half Life: Approximately 15-48 hours, varies with dose and frequency.

Contraindications

• History of porphyria, respiratory depression, or hypersensitivity to barbiturates.

Precautions

• Use with caution in patients with a history of substance abuse, elderly, pregnancy, and in those with hepatic or renal impairment. Avoid abrupt discontinuation to prevent withdrawal symptoms.
• Pregnancy category D: risk to fetus; use only if benefits outweigh risks.

Adverse Reactions - Common

• Drowsiness (Common)
• Dizziness (Common)
• Memory impairment (Common)

Adverse Reactions - Serious

• Respiratory depression (Less common but serious)
• Dependence and addiction (Serious)
• Potential for overdose leading to coma or death (Serious)

Drug-Drug Interactions

• Other CNS depressants (e.g., alcohol, benzodiazepines, opioids) increase sedation and respiratory depression risk.
• CYP450 enzyme inducers (e.g., rifampin) may decrease effectiveness.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Take medication exactly as prescribed.
• Do not combine with alcohol or other CNS depressants.
• Warn about daytime drowsiness and impaired coordination.
• Do not abruptly stop medication; consult provider for tapering plan.

Special Considerations

Black Box Warnings:

• Potential for serious respiratory depression and dependence.
• Use with caution in elderly due to increased sensitivity and risk of falls.

Genetic Factors: None specifically identified.

Lab Test Interference: May affect liver function tests or other hepatic enzymes.

Overdose Management

Signs/Symptoms: Profound sedation, respiratory depression, coma, pinpoint pupils.

Treatment: Supportive care including airway management, supporting ventilation, activated charcoal if recent ingestion, and gastric lavage as appropriate. No specific antidote; consider use of barbiturate-specific rescue medications if available.

Storage and Handling

Storage: Store in a tight, light-resistant container at room temperature.

Stability: Stable under recommended storage conditions.