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Pentobarbital Use, Addiction, And Treatment Options

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Pentobarbital is a potent prescription barbiturate drug with a high potential for use and addiction. For these reasons, even within prescribed use, this substance is highly monitored and recommended for only brief periods of treatment.

When used to excess and/or for long periods of time, the side effects of barbiturates could be disabling, and in certain cases, life-threatening. Pentobarbital use can cause a declining quality of life, dependence, dangerous withdrawal and fatal overdose.

While anyone who misuses this drug can become addicted, individuals struggling with alcoholism, opioid use disorders, amphetamine use or use of other sedative-hypnotics are more vulnerable to barbiturate use and dependence.

For these individuals, and those who use barbiturates alone, comprehensive treatment could be the difference between a continued life of addiction and hope and recovery success.

What Is Pentobarbital?

Pentobarbital is a short-acting barbiturate. This means the effects of the drug are felt quite quickly, however, they do not last that long compared to long-acting drugs.

Pentobarbital is the generic form of the following brand name prescription drugs:

  • Nembutal
  • Pentosol
  • Repocal
  • Sopental

Pentobarbital is delivered two ways, either in an oral or parenteral (non-oral) form. The oral capsule is currently not available in the United States, however, the parenteral form may be mixed with flavored syrup and delivered by mouth.

In addition to this, the parenteral form can be administered through an IV or by an intramuscular injection (the drug is injected into the muscle). In certain cases, this drug may be administered rectally. When used, a person may use the drug any of these ways.

As a barbiturate and central nervous system (CNS) depressant, this drug can produce drowsiness, sedation and a hypnotic state. For these reasons, it may be used prior to surgery, to reduce seizure activity or in more limited instances, as a sleeping pill for insomnia.

Pentobarbital can quickly cause a tolerance. Because of this, its use as a medication for insomnia is not typically accepted or recommended for prolonged periods of time. If, however, it’s used to treat problems sleeping, it’s recommended that the medication is used no more than two weeks.


About Pentobarbital Use

Pentobarbital’s ability to cause a rapid tolerance is one reason why a person may become addicted to this drug quickly. To fight the effects of a tolerance, many people increase their dose, an action that can accelerate addiction.

Pentobarbital, or Nembutal, is a Schedule II controlled substance. This means that it can cause psychological and/or physical dependence that further deepens the hold of addiction. The combination of these effects gives pentobarbital a high potential for use and addiction.

The hypnotic effect of pentobarbital lasts one to four hours, however, it remains in a person’s system for 15 to 50 hours, depending on a person’s dose. As a short-acting drug, a person may take frequent doses to maintain their high, behaviors that can fuel addiction.

When used for insomnia, a person may receive 150 to 200 mg once a day at a bed. The typical person struggling with addiction to barbiturates is reported to use 1.5 grams per day, a dose ten or more times higher than these prescribed doses.

Barbiturates were once prescribed fairly heavily, however, due to their potential for dependence and overdose, they are largely out of favor with prescribers.

Instead, benzodiazepine drugs are prescribed for similar purposes, due to their lower potential for overdose. Despite this, addiction to an overdose of benzodiazepine drugs is still possible. But even with the reduced number of barbiturate prescriptions today, use and addiction do still happen. When used, barbiturates may be referred to as “Barbs.”

Signs And Symptoms Of Pentobarbital Use

Pentobarbital exerts a profound effect on a person’s mental and physical states, especially at levels of use. When this happens, a person will begin to experience a variety of side effects, some of which will become visible to an observer. In addition to this, the way a person acts and relates to people around them can drastically change.

Mental Signs Of Pentobarbital Use

Though short-term pentobarbital use can cause mental symptoms, such as confusion, impaired judgment, and trouble thinking, heavy, long-term barbiturate use may produce certain chronic side effects, such as:

  • an altered level of alertness
  • decreased functioning
  • irritability
  • memory loss

Some people may self-medicate emotional problems or mental health disorders with pentobarbital. Not only can this worsen certain psychological problems, but it can also create an environment that fosters addiction.

Physical Signs Of Pentobarbital Use

Due to the drug’s sedative and hypnotic properties, even small amounts of pentobarbital can cause physical changes. The greater the amount used, the more apparent certain effects may be. Physical side effects of pentobarbital use may include:

  • blurred vision
  • dizziness
  • drowsiness
  • insomnia
  • nausea
  • sedation
  • slurred speech
  • unsteadiness
  • vomiting

Continuing to use a drug, despite the ill side effects it causes, is one characteristic of addiction.

Behavioral Signs Of Pentobarbital Use

As a person’s use becomes more frequent, compulsive patterns may emerge. When drug seeking and using begin to outweigh a person’s habits of self-care or desire to fulfill important responsibilities, other characteristics of addiction will likely be present.

Drug use changes the way a person functions in their day-to-day lives. As a substance use disorder takes hold, a person may exhibit the following behavioral signs of use.

A person:

  • uses the drug in greater quantities or for longer than they intended.
  • cannot reduce the amount they use or quit even when they want to.
  • loses large amounts of time to using the drug or feeling ill from its effects.
  • frequently experiences overwhelming urges or thoughts to use the drug (cravings).
  • has trouble in their family, at home, at work or at school due to their drug use.
  • continues to use the drug even when their relationships begin to suffer.
  • no longer takes part in activities or hobbies they once enjoyed and instead spends time using the drug.
  • takes part in dangerous or risky behaviors while using the drug.
  • continues to use the drug even when it’s causing or aggravating a mental health problem.
  • finds that the amount they’re used to using doesn’t create the feelings they want (a tolerance).
  • becomes sick if they suddenly stop using the drug or if they alter the dose by a large amount (withdrawal).

In order to maintain a constant supply of the drug to use, a person may steal other people’s prescriptions or pretend they have a medical condition so they can receive their own prescription. If a person is misusing their own prescription they may go through the prescription faster than they should be as well.

When questioned about their substance use, a person may lie, act evasive, become angry or claim they need the drug to function in a normal way.

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Risks And Dangers Of Pentobarbital Use

Pentobarbital use can endanger a person’s health, causing physical and mental health problems that range from mild to severe. Use of this drug may cause:

  • falls and injuries
  • impaired driving and car accidents
  • an increased risk of osteopenia/osteoporosis

Further, women who use this drug while pregnant can expose their baby to serious adverse health effects, including addiction, birth defects, hemorrhage at birth, impaired brain development, intelligence deficits, and withdrawal symptoms.

Elderly or geriatric people can experience the sedative effects of pentobarbital more intensely. Prescribed use or use at these ages can be accompanied by the following risks:

  • a high rate of physical dependence
  • tolerance to the drug’s sleep-inducing effect
  • the potential for an overdose at low dosages

While certain forms of drug use may be more common in younger individuals, substance use can happen and be dangerous at any age.

With its strong ability to depress the central nervous system, one of the gravest dangers of pentobarbital use is an overdose. Even if an overdose doesn’t take a person’s life, it could cause other serious medical conditions, such as cardiac arrhythmias, congestive heart failure, pneumonia, pulmonary edema, and renal failure.

Signs Of A Pentobarbital Overdose

Pentobarbital can cause a deadly overdose. The effects of this drug can be so strong that some states use it to induce death during physician-assisted suicide or to bring about sleep during lethal injection. When used, even a small amount could cause an overdose in a person who is abusing it for the first time.


At certain dosages of use, the body cannot keep up with the amount of pentobarbital entering its system. As this occurs, the drug can reach toxic levels and cause the central nervous system to malfunction. The CNS depression that follows can cause a person’s blood pressure, breathing, heart and temperature rates to fall, a state that can cause death.

Signs of a pentobarbital overdose include:

  • agitation
  • confusion
  • decreased body temperature
  • decreased energy
  • extreme sleepiness
  • a headache
  • skin eruptions, rash and/or large blisters
  • slurred speech
  • stopped, slowed or difficult breathing
  • trouble walking

In the most serious of cases, a person could become unresponsive, become unconscious, slip into a coma or develop typical shock syndrome. In certain cases, these states may become so advanced that a person dies.

Using pentobarbital with other CNS depressants, such as alcohol, benzodiazepines (Klonopin and Xanax) and opioids (heroin and OxyContin) can increase the level of central nervous system depression. In fact, the majority of barbiturate-related overdose deaths involve alcohol and opiates or a combination of all three.

Polydrug use can make the amount of drug(s) needed to cause overdose less. For instance, if a person is drinking, a smaller amount of pentobarbital than they’re normally accustomed to taking could cause an overdose.

Signs And Symptoms Of Pentobarbital Withdrawal

Frequent episodes of pentobarbital use can lead to dependence. The more a person uses, the greater the level of physical dependence and intensity of withdrawal symptoms. According to DailyMed, a person who takes more than 400 mg for 90 days will develop some level of dependence. Taking more than this could cause dependence to happen sooner.

In a dependent state, a person’s body begins to rely on the barbiturate to function. Without it, the body reacts in shock, becoming sick. The timeline of pentobarbital withdrawal can vary per person, but typically minor withdrawal begins in eight to 12 hours after a person consumes their last dose. Once minor withdrawal sets in, symptoms can develop in the following order:

  • anxiety
  • muscle twitching
  • hand tremors
  • weakness
  • dizziness
  • changes in vision
  • nausea
  • vomiting
  • insomnia
  • orthostatic hypotension

A person may also experience sleep disruption during withdrawal, including:

  • frequent dreaming
  • insomnia
  • nightmares

Major withdrawal can happen anywhere from 16 hours to five days after a person last uses this drug. Like withdrawal from alcohol and benzodiazepines, major withdrawal from barbiturates like pentobarbital could become severe, causing death.

When this happens, a person may experience delirium and convulsions. DailyMed continues, cautioning that using dosages of 600 to 800 mg for 35 days or more can cause withdrawal seizures.


Medically Supervised Pentobarbital Detoxification

Intensive medical care could stabilize a person’s vitals and protect a person’s life during the dangerous states of major pentobarbital, or Nembutal, withdrawal.

Even if a person doesn’t progress to this point, in an inpatient detox program, medical treatments and personnel are on hand 24/7 to ensure that a person remains protected and as comfortable as possible. The best medical detox programs provide these services so that a person’s body can begin to heal and cleanse the drug from its system.

During this time, trained clinicians may use medications to reduce or alleviate minor withdrawal symptoms. A tapering or weaning schedule will likely be used to help a person’s body safely acclimate to the absence of the drug.

Getting Treatment For Pentobarbital Addiction

Addressing withdrawal and physical dependence makes up just one part of treatment. Once a person’s body has begun to work in a more normal and healthy way, drug rehab can begin.

Outpatient and inpatient treatment options for pentobarbital exist, however, due to the level of psychological dependence this substance can cause, many people may achieve greater success in an inpatient drug rehab center.

Evidence-based treatments for pentobarbital addiction, such as behavioral therapies, will be customized to fit a person’s needs. Residential treatment also provides greater opportunities for people with co-occurring mental health disorders who need dual diagnosis treatment.

Selecting a program that provides these tailored, individualized services can better help a person to build a strong and resilient foundation for a drug-free life.

Contact Vertava Health for more information on pentobarbital use, addiction, and treatment.