01Nembutal Pentobarbital sodium

01Nembutal Pentobarbital sodium

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Description

01nembutal-pentobarbital-sodium

01Nembutal Pentobarbital sodium for sale

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Barbiturates, Plain (Buy 01Pentobarbital Nembutal Sodium)

01Nembutal Pentobarbital sodium for sale

DEA CLASS

Rx, schedule II

Buy 01Pentobarbital Nembutal Sodium

Short-acting oral and parenteral barbiturate; for preoperative anxiety, sedation, refractory seizures, or to induce coma for increased intracranial pressure; rarely used for insomnia due to rapid development of tolerance; close monitoring for emerging or worsening suicidal thoughts/behavior or depression is recommended.

COMMON BRAND NAMES

Nembutal

HOW SUPPLIED

Nembutal/Pentobarbital Sodium Intramuscular Inj Sol: 1mL, 50mg
Nembutal/Pentobarbital Sodium Intravenous Inj Sol: 1mL, 50mg

DOSAGE & INDICATIONS

For procedural sedation or for use as a preanesthetic medication.
Intramuscular dosage
Adults

150 to 200 mg IM. Use a reduced dosage in debilitated or geriatric patients.

Infants, Children, and Adolescents ( Buy 01Pentobarbital Nembutal Sodium )

2 to 6 mg/kg/dose IM (Max: 100 mg/dose). If adequate sedation is not achieved 1 hour after administration, an additional 1 to 3 mg/kg/dose may be given.

Intravenous dosage
Adults

100 mg IV is a common, initial dose for a 70-kg adult. Allow at least 1 minute to assess full effect of dose. Additional doses may be given up to a total of 200 to 500 mg. Use a reduced dosage in debilitated or geriatric patients.

Oral dosage

NOTE: Oral capsules are no longer commercially available in the US. Although details regarding stability are not available, the parenteral solution has been mixed in a 3:1 ratio with cherry syrup and given orally. In these pediatric studies, oral pentobarbital was better tolerated and as effective as the comparator (IV pentobarbital or chloral hydrate).

Children and Adolescents 4 years and older

1.5 to 3 mg/kg/dose PO. Max: 100 mg/dose. The FDA-approved labeling for oral capsules in pediatric patients is 2 to 6 mg/kg/24 hours and dependent on age, weight, and degree of desired sedation.

Children 1 to 3 years

3 to 6 mg/kg/dose PO. Max: 100 mg/dose. The FDA-approved labeling for oral capsules in pediatric patients is 2 to 6 mg/kg/24 hours and dependent on age, weight, and degree of desired sedation.

Infants

4 mg/kg/dose PO. Additional doses of 2 to 4 mg/kg/dose may be administered every 30 minutes as needed for adequate sedation. Max total dose: 8 mg/kg. The FDA-approved labeling for oral capsules in pediatric patients is 2 to 6 mg/kg/24 hours and dependent on age, weight, and degree of desired sedation.

For use as an alternative agent in the treatment of status epilepticus or for acute control of tonic-clonic seizures from meningitis, tetanus or chorea, ethanol withdrawal, eclampsia, or poisons.
Intravenous dosage ( Buy Pentobarbital Nembutal Sodium ) 
Adults

5 to 15 mg/kg IV load at a rate of 50 mg/minute or less, followed by a continuous infusion of 0.5 to 5 mg/kg/hour IV. An additional loading dose of 5 to 10 mg/kg may be given. Titrate infusion by 0.5 to 1 mg/kg/hour every 12 hours to clinical response. The goal is an induced coma state characterized by absent brainstem reflexes and suppression of the EEG. Maintain EEG burst suppression for 12 to 48 hours before tapering the infusion; some experts recommend decreasing infusion by 0.5 mg/kg/hour every 12 hours. Monitor EEG and blood pressure. Although intermittent IV infusion of pentobarbital is FDA-approved for the treatment of status epilepticus, specific dosing recommendations are not available. Further, clinical practice guidelines recommend continuous IV infusion of pentobarbital for refractory status epilepticus.

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Neonates, Infants, Children, and Adolescents

5 to 15 mg/kg IV load over 1 hour, followed by a continuous infusion of 1 mg/kg/hour IV. Mechanical ventilation required. Titrate infusion to clinical response; dosage range 0.5 to 5 mg/kg/hour. The goal is an induced coma state characterized by absent brainstem reflexes and suppression of the EEG. Maintain EEG burst suppression for 12 to 48 hours before tapering the infusion; some experts recommend decreasing infusion by 0.5 mg/kg/hour every 12 hours. Monitor EEG and blood pressure. Neonates may be at greater risk for adverse effects.  Although intermittent IV infusion of pentobarbital is FDA-approved for the treatment of status epilepticus, specific dosing recommendations are not available. Further, clinical practice guidelines recommend continuous IV infusion of pentobarbital for refractory status epilepticus.

For the short-term treatment of insomnia.
Intramuscular dosage
Adults

150 to 200 mg IM at bedtime. Use a reduced dosage in debilitated patients. Clinical practice guidelines no longer recommend barbiturates for insomnia.

150 to 200 mg IM at bedtime. Use a reduced dosage in geriatric patients. Clinical practice guidelines no longer recommend barbiturates for insomnia.  The federal Omnibus Budget Reconciliation Act (OBRA) regulates the use of barbiturates in residents of long-term care facilities (LTCFs). Barbiturates should not be initiated in any dose to treat insomnia in a resident of a LTCF since they are highly addictive and can cause multiple adverse effects (e.g., adverse CNS effects, hypotension, increased risk for falls), especially in geriatric patients.

Infants, Children, and Adolescents

2 to 6 mg/kg/dose IM at bedtime (Max: 100 mg/dose). Clinical practice guidelines no longer recommend barbiturates for insomnia.

For the reduction of increased intracranial pressure (ICP)† in patients with traumatic brain injury (i.e., head trauma)†.
Continuous Intravenous Infusion dosage
Adults

10 mg/kg IV load over 30 minutes, then 5 mg/kg/dose IV every 3 hours for 3 doses, then a continuous infusion of 1 mg/kg/hour IV. Mechanical ventilation required. Titrate infusion to clinical response; dosage range 1 to 2 mg/kg/hour. In general, barbiturate coma is reserved for hemodynamically stable patients with persistent elevations of ICP greater than 20 to 25 mmHg. The goal is an induced coma state characterized by absent brainstem reflexes and suppression of the EEG. Monitor ICP, mean arterial pressure, cerebral perfusion pressure, and EEG burst suppression. To minimize the risk of cerebral hypoxia, monitor arteriovenous oxygen saturation. Taper pentobarbital after 24 hours of controlled ICP.  Buy 01Pentobarbital Nembutal Sodium

Children and Adolescents

10 mg/kg IV load over 30 minutes, then 5 mg/kg/dose IV every 3 hours for 3 doses, then a continuous infusion of 1 mg/kg/hour IV. Mechanical ventilation required. Titrate infusion to clinical response; dosage range 1 to 2 mg/kg/hour. In general, barbiturate coma is reserved for hemodynamically stable patients with persistent elevations of ICP greater than 20 to 25 mmHg. The goal is an induced coma state characterized by absent brainstem reflexes and suppression of the EEG. Monitor ICP, mean arterial pressure, cerebral perfusion pressure, and EEG burst suppression. To minimize the risk of cerebral hypoxia, monitor arteriovenous oxygen saturation. Taper pentobarbital after 24 hours of controlled ICP.

Intermittent Intravenous dosage
Infants, Children, and Adolescents

5 mg/kg/dose IV every 4 to 6 hours has been suggested. Some experts suggest this lower dose may be effective and avoid hypotensive effects; data suggests complete burst suppression on EEG may not be necessary for pentobarbital’s protective effects. Mechanical ventilation required. Titrate as needed to treat elevated ICP. 01Nembutal Pentobarbital sodium for sale

For sedation maintenance† and to alleviate agitation† and anxiety† in patients refractory to standard therapy who are mechanically-ventilated.
Continuos Intravenous Infusion dosage
Infants, Children, and Adolescents

1 to 2 mg/kg IV load, then a continuous infusion of 1 to 2 mg/kg/hour IV. May administer bolus doses equivalent to the hourly rate of infusion every 2 hours as needed; if 4 to 6 boluses or more are needed in a 24-hour period, increase infusion rate by 1 mg/kg/hour. Titrate to adequate sedation; reported range is 1 to 6 mg/kg/hour (median range 2 mg/kg/hour). Monitor blood pressure. Gradually taper infusion or convert to an oral barbiturate (e.g., phenobarbital) after prolonged therapy to avoid symptoms of withdrawal. Pentobarbital therapy is an alternative option for sedation in those who fail standard therapy; significant complications including hypotension, oversedation, neurologic sequelae, and drug reaction limit its use. 01Nembutal Pentobarbital sodium for sale

†Indicates off-label use

MAXIMUM DOSAGE

Adults ( Buy 01Pentobarbital Nembutal Sodium ) 

Specific maximum dosage information not available; individualize dosage based on clinical parameters and serum pentobarbital concentrations.

Geriatric

Specific maximum dosage information not available; individualize dosage based on clinical parameters and serum pentobarbital concentrations.

Adolescents

Specific maximum dosage information not available; individualize dosage based on clinical parameters and serum pentobarbital concentrations. For procedural sedation, doses above 6 mg/kg/dose IM/IV/PO (Max: 100 mg/dose) are not usually necessary.

Children

Specific maximum dosage information not available; individualize dosage based on clinical parameters and serum pentobarbital concentrations. For procedural sedation, doses above 6 mg/kg/dose IM/IV/PO (Max: 100 mg/dose) are not usually necessary.

Infants

Specific maximum dosage information not available; individualize dosage based on clinical parameters and serum pentobarbital concentrations. For procedural sedation, doses above 6 mg/kg/dose IM or IV and 8 mg/kg/dose PO (Max: 100 mg/dose) are not usually necessary. 01Nembutal Pentobarbital sodium for sale

Neonates

Specific maximum dosage information not available; individualize dosage based on clinical parameters and serum pentobarbital concentrations. For procedural sedation, doses above 6 mg/kg/dose IV are not usually necessary.

Buy 01Pentobarbital Nembutal Sodium

01Nembutal Pentobarbital sodium for sale

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