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Active Ingredients: PENTOBARBITAL SODIUM

Dosage Form:LIQUID and SOLUTION

Dosage Strength: 100MG/ML

Regulatory Information: Schedule G (CDSA IV)

Packaging Presentation:100ML

Nembutal Pentobarbital sodium injection is a short-acting barbiturate, chemically designated as sodium 5-ethyl-5-(1-methylbutyl) barbiturate. This is one of the reasons for being more suitable for suicide than longer-acting barbiturates such as phenobarbital.Nembutal is a proven, reliable drug that brings about a peaceful death. Almost no failures are known, despite large statistics (for example, the Swiss euthanasia organisation Dignitas reported 840 exits with no single failure). There are however reports on seemingly slow or painful deaths with Nembutal in capital punishment, although this may be due to poor quality of the drug from compounding pharmacies given intravenously rather than orally.

Nembutal Pentobarbital sodium injection is sold most of the time in liquid form for use as a sedative and anesthetic in hospitals. veterinary Nembutal is a liquid and not in pill-form, which means that it has a shorter shelf life. On the other hand, Seconal (secobarbital), a short acting barbiturate that is as powerful as Nembutal if not more powerful, is still available in capsule form in the USA, EUROPE and probably the UK. Nembutal pills has a bitter taste that require the use of anti-emetics to prevent vomiting when given orally at high dosages.

It is easy from today form today to obtain vials of Nembutal Sodium Solution (pentobarbital sodium injection), a sterile solution for intravenous or intramuscular injection, typically used for animal anaesthesia or euthanasia. Each mL contains pentobarbital sodium 50 mg ,100 mg or 250 mg (lethal dose) in a vehicle of approximately propylene glycol, 40%, alcohol, 10% and water for injection, to volume. The pH is adjusted to approximately 9.5 with hydrochloric acid and/or sodium hydroxide. The range of actual pentobarbital sodium in a vial may vary between 3 g to 15 g, although 6 g seems common. The containers come in a clear vial typical for sterile solutions, and should have an untouched protective metal cap if unopened, and be labelled clearly with due date. The nembutal solution may be taken intravenously, for very quick effect as in capital punishment, or orally.

Nembutal Pentobarbital sodium injection, unlike other lethal drugs, may not require any additional drugs. Only anti-emetic drugs must be taken in advance, in order to prevent any vomiting from occurring. This has been partially endorsed by experts in administration of the death penalty, whereby a pure barbiturate method has been deemed less painful and more successful than prior 3-drug approaches and newer concoctions involving e.g. Midazolam (in the traditional 3-drug approach, a barbiturate was one of the components). There have, however, been reports of less successful attempts, the cause of which have been debated. The use of pentobarbital-only has also been called into question by some experts on capital punishment.

DOSAGE AND ADMINISTRATION
Dosages of barbiturates must be individualized with full knowledge of their particular characteristics and recommended rate of administration. Factors of consideration are the patient’s age, weight, and condition. Parenteral routes should be used only when oral administration is impossible or impractical.

Intramuscular Administration: IM injection of the sodium salts of barbiturates should be made deeply into a large muscle, and a volume of 5 mL should not be exceeded at any one site because of possible tissue irritation. After IM injection of a hypnotic dose, the patient’s vital signs should be monitored. The usual adult dosage of NEMBUTAL (pentobarbital) Sodium Solution is 150 to 200 mg as a single IM injection; the recommended pediatric dosage ranges from 2 to 6 mg/kg as a single IM injection not to exceed 100 mg.

Intravenous Administration: Nembutal Pentobarbital sodium injection (pentobarbital) Sodium Solution should not be admixed with any other medication or solution. IV injection is restricted to conditions in which other routes are not feasible, either because the patient is unconscious (as in cerebral hemorrhage, eclampsia, or status epilepticus), or because the patient resists (as in delirium), or because prompt action is imperative. Slow IV injection is essential, and patients should be carefully observed during administration. This requires that blood pressure, respiration, and cardiac function be maintained, vital signs be recorded, and equipment for resuscitation and artificial ventilation be available. The rate of IV injection should not exceed 50 mg/min for pentobarbital sodium.

There is no average intravenous dose of NEMBUTAL Sodium Solution (pentobarbital sodium injection) that can be relied on to produce similar effects in different patients. The possibility of overdose and respiratory depression is remote when the drug is injected slowly in fractional doses.

Anticonvulsant use: In convulsive states, dosage of Nembutal Pentobarbital sodium injection should be kept to a minimum to avoid compounding the depression which may follow convulsions. The injection must be made slowly with due regard to the time required for the drug to penetrate the blood-brain barrier.

Special patient population: Dosage should be reduced in the elderly or debilitated because these patients may be more sensitive to barbiturates. Dosage should be reduced for patients with impaired renal function or hepatic disease.

Inspection: Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution containers permit. Solutions for injection showing evidence of precipitation should not be used.

Potentiating the cocktail and masking the taste
It is usually recommended to drink some alcohol immediately after (not prior) to the Nembutal ingestion to potentiate its effect and mask the very bitter taste.
Eating a big meal prior to or after the drug ingestion is not recommended to reduce chances of slow drug absorption or vomiting. Dignitas offers clients chocolates to deal with the bitter taste of the drug.

Time To Death
Experience in the world has learned that after injecting 50 grams of either or lethal dose pentobarbital or secobarbital, death generally occurs within two hours maximum

Overdose effects
A pentobarbital overdose is an amount taken in excess of that which is medically recommended. Two to ten grams excess can cause death

In extreme overdose, all electrical activity in the brain may cease, in which case a “flat” EEG normally equated with clinical death cannot be accepted. This effect is fully reversible unless hypoxic damage occurs. Consideration should be given to the possibility of barbiturate intoxication even in situations that appear to involve trauma.

Complications such as pneumonia, pulmonary edema, cardiac arrhythmias, congestive heart failure, and renal failure may occur. Uremia may increase CNS sensitivity to barbiturates. Differential diagnosis should include hypoglycemia, head trauma, cerebrovascular accidents, convulsive states, and diabetic coma

HOW SUPPLIED
Nembutal Pentobarbital sodium injection is available in the following sizes: 20ml, 50ml 100 ml, powder

SIDE EFFECTS
The following adverse reactions and their incidence were compiled from surveillance of thousands of hospitalized patients. Because such patients may be less aware of certain of the milder adverse effects of barbiturates, the incidence of these reactions may be somewhat higher in fully ambulatory patients.

More than 1 in 100 patients. The most common adverse reaction estimated to occur at a rate of 1 to 3 patients per 100 is: Nervous System: Somnolence.

Less than 1 in 100 patients. Adverse reactions estimated to occur at a rate of less than 1 in 100 patients listed below, grouped by organ system, and by decreasing order of occurrence are:

Nervous system: Agitation, confusion, hyperkinesia, ataxia, CNS depression, nightmares, nervousness, psychiatric disturbance, hallucinations, insomnia, anxiety, dizziness, thinking abnormality.

Respiratory system: Hypoventilation, apnea.

Cardiovascular system: Bradycardia, hypotension, syncope.

Digestive system: Nausea, vomiting, constipation.

Other reported reactions: Headache, injection site reactions, hypersensitivity reactions (angioedema, skin rashes, exfoliative dermatitis), fever, liver damage, megaloblastic anemia following chronic phenobarbital use.

Animal Euthanasia
However, experts in human anaesthesia have pointed out that pentobarbital, while an anaesthetic, is not a full analgesic. As such, coadministration of an appropriate analgesic may be advisable to completely eliminate risk of perceived pain, although reports of adverse events have been sparse. Suggestions for analgesics seem unclear at this time, perhaps a low-moderate dose opioid could be an option. The US Death with Dignity homepage mentions a mix of phenobarbital, choral hydrate, morphine sulfate and ethanol as a less expensive option to secobarbital. These additions are possibly due to phenobarbital being slower acting. In veterinary euthanasia, a two step approach is favoured, whereby a sedative such as propofol is given prior to an IV pentobarbital dose. Oral administration is recommended only as a fallback. This method may differ slightly in effect from oral human consumption in that death occurs almost immediately, and perhaps by cardiac effects rather than respiratory depression. In the recorded events of adverse events where IV pentobarbital was used for capital punishment, the likely cause was contaminated pentobarbital from a compounding pharmacy, something which should pose a small risk when taken orally.