Barbiturates

What are barbiturates?

Barbiturates are medications that cause you to relax or feel drowsy. They can also stop or prevent convulsions and seizures. The most common uses are for anesthesia reasons, treating epilepsy and nonepileptic seizures, insomnia and other conditions.

Barbiturates belong to the sedative-hypnotic class of medications. Sedatives are medications that help you calm down and relax. Hypnotics make you drowsy (their name comes from the word “hypnos,” which means “sleep” in Greek).

Barbiturates affect your brain by increasing a brain chemical called gamma-aminobutyric acid (GABA), which slows down the activity of your brain cells.

Why do doctors prescribe barbiturates?

In years past, barbiturates were a common part of general anesthesia in surgeries. That’s because these medications help ease a person into a deep sleep. Today, other medications do this job better.

However, barbiturates are still proven medications for treating many conditions. They also combine well with other medications like acetaminophen (Tylenol® or Paracetamol®) to treat certain conditions.

What conditions do barbiturates treat?

Barbiturates can treat several conditions.

The most common uses are:

• Preventing seizures.
• Treating insomnia.
• Pre-anesthesia sedation (they help a person fall asleep quickly and pleasantly) and anxiety reduction.
• Treating high cerebrospinal fluid pressure inside the skull (intracranial hypertension).

While barbiturates are useful for the above listed, some of these uses are less common in certain countries. For example, barbiturates are less common for pre-anesthesia in the United States because many newer drugs are more effective and have fewer side effects.

How commonly prescribed are barbiturates?

Barbiturates aren’t as common as in years past because newer drugs have largely taken their place. However, many of these drugs still see widespread use for specific conditions. Phenobarbital, for example, is common for treating seizures that resist first-line anti-seizure medications.

Which drugs are barbiturates?

There are several barbiturates available worldwide, but some of these aren’t available in certain countries. An example is thiopental, which isn’t available in the United States anymore. Some of the most common barbiturates include:

• Amobarbital. This can treat insomnia, but it’s only effective in the short term. It can also help with certain neurological (brain function) tests.
• Butalbital. This medication is part of many combination medications, including aspirin, acetaminophen, caffeine and codeine. Depending on the combination, it can treat migraines and tension headaches.
• Methohexital. This medication is useful for anesthesia in short diagnostic and treatment procedures. It’s very helpful in procedures like electroconvulsive therapy.
• Pentobarbital. This medication is useful for pre-anesthesia. It can also stop seizures as they’re happening.
• Phenobarbital. This medication is also useful for preventing seizures or stopping them when they’re happening.
• Primidone. This medication prevents convulsions, making it useful for preventing seizures.
• Secobarbital. This medication treats insomnia, but this is less common, and many healthcare providers avoid prescribing it.

What are the advantages of these medications?

Barbiturates have many advantages. They’re older medications, which means they have decades of research to back them up. They can also serve as backup when the first-line medications don’t work.

One of the most important advantages of barbiturates is how long they last. Some of these medications are only effective for a very brief time. That’s useful during short medical procedures. Others can last for hours or even days, which is one reason healthcare providers still prescribe them to prevent seizures.

Experts divide these medications into groups depending on the timing of their effectiveness.

• Ultra-short-acting. An example of this is methohexital. When given in an intravenous (IV) line, it wears off in 15 minutes or less. In rectal suppository form, it wears off in 45 to 60 minutes.
• Short-acting. Pentobarbital and secobarbital fall into this category. They last about three to four hours.
• Intermediate-acting. Amobarbital and butalbital both fall into this category. Amobarbital lasts about four to six hours. Butalbital is usually effective for about four hours.
• Long-acting. Phenobarbital is the best example of long-acting barbiturates. The phenobarbital effects last up to 12 hours, but they may remain in your system for several days.

What are the risks or complications of taking barbiturates?

One of the main reasons barbiturates aren’t in common use anymore is they have higher risks of certain side effects, including:

• Tolerance and possible dependence or addiction. Medication tolerance is when your body gets used to a drug’s effect, meaning you need higher doses. Dependence is when your body is so used to a drug that you develop unpleasant or dangerous symptoms if you go too long without taking the drug. Addiction is a mental health condition where dependence disrupts your life, where you are compulsively seeking and using the drug despite adverse consequences.
• Heart and breathing disruptions. Barbiturates lower your heart rate and blood pressure. Taking too much of a barbiturate could cause you to stop breathing, which is a life-threatening medical emergency. That means misusing these medications can be very dangerous.
• They interact with many other medications. Barbiturates affect your liver, making it process certain other drugs too quickly. That makes other medications less effective when you take them simultaneously with barbiturates.
• They may disrupt fetus development and can affect breastfeeding infants. People who are pregnant shouldn’t take barbiturates. They can also pass through breast milk.

When should I see my healthcare provider?

You should see your healthcare provider as recommended. Most barbiturates aren’t for long-term use, so you might need to see your healthcare provider for follow-up. That will let them determine if you still need treatment or if other options will work better.

You should also see your healthcare provider if you notice that barbiturate medications aren’t working as they should or if the side effects are disrupting your usual routine and activities.

When should I go to the emergency room?

You should go to the emergency room if you have the symptoms of a barbiturate overdose, which can look similar to alcohol intoxication. These include:

• Trouble breathing (dyspnea).
• Confusion or trouble thinking.
• Passing out or fainting.
• Slow pulse (bradycardia); however, barbiturate overdose can also cause a fast, weak pulse.
• Dizziness and vertigo.
• Nausea and vomiting.
• Low body temperature (hypothermia).
• Muscle weakness.
• Feeling very thirsty.
• A blue tint to lips or fingernails (cyanosis).
• Unfocused or rapidly shifting eyes, or eyes with unusually small or large pupils.

Are barbiturates the same as benzodiazepines?

Barbiturates and benzodiazepines aren’t the same types of medications, but they’re very similar. They both can stop seizures, cause you to relax and feel less anxious, or can help you feel drowsy and fall asleep when you receive general anesthesia.

For the most part, healthcare providers often prescribe benzodiazepines before trying a barbiturate. Benzodiazepines have fewer side effects and are safer. They’re also less prone to misuse. Combining benzodiazepines and barbiturates can be very dangerous, so you should never combine them unless a doctor prescribes them this way.

Can I drink alcohol if I’m taking barbiturates?

No, you shouldn’t drink alcohol if you’re taking barbiturates. Alcohol and barbiturates can interact and cause a much stronger effect. This can cause severe drowsiness, passing out or trouble breathing. In severe cases, this could cause a person to have severe organ damage, or it could be deadly.

Are barbiturates dangerous?

Barbiturates have some risks, but these risks should be minimal if you take your medication exactly as prescribed. You also shouldn’t have a problem with barbiturate dependence if you take your medication as your healthcare provider instructs.

Barbiturate dependence and withdrawal

Over time, your body develops a dependence on barbiturates. That means your body needs the drug, and if you don’t get it, you can experience withdrawal symptoms. These symptoms include:

• Agitation and nervousness.
• Tremor or shaking, especially in your hands.
• Confusion or delirium.
• Severe seizures.

Taking these medications as prescribed can reduce the risk of developing dependence, but some people may still have this problem. You shouldn’t ignore the symptoms of barbiturate withdrawal. In severe cases, barbiturate withdrawal is dangerous or even deadly.

Why you should tell your provider

You may feel worried or anxious about telling your healthcare provider that you’re experiencing symptoms that might mean you’re developing dependence on these drugs. However, developing a dependence on these medications is common. That’s a major reason why healthcare providers prescribe them less commonly these days.

If you notice withdrawal symptoms when you stop taking barbiturate medications, you should talk to your healthcare provider. Telling them about these symptoms means they can help reduce your dose until these symptoms stop. That can help you avoid problems related to barbiturate misuse, such as barbiturate addiction.

Keeping these medications secure

A key reason why healthcare providers don’t prescribe barbiturates as often now is the risk of misusing them. Because of that risk, you should keep these medications under lock and key in a secure place in your home. Keeping them out of the hands of children and teenagers is essential. Acting cautiously can help avoid accidental poisoning or recreational misuse of these medications, both of which can have deadly consequences.

A note from Cleveland Clinic

Barbiturates are medications that cause you to relax or feel drowsy. Barbiturates have been around since the 1860s, and they still see a use for many conditions today. Though they’re not as common anymore, these medications still help people with a wide range of medical conditions. However, you should use them cautiously, taking them exactly as prescribed. Your healthcare provider can tell you more about what to expect and how to use these medications so they help you as they should.