Pentobarbital (US) orpentobarbitone (British and Australian) is a short-actingbarbiturate typically used as asedative, apreanesthetic, and to controlconvulsions in emergencies.[3] It can also be used for short-term treatment ofinsomnia but has been largely replaced by thebenzodiazepine family of drugs.
Pentobarbital was widelyabused beginning in the late 1930s and sometimes known as "yellow jackets" due to the yellow color of Nembutal-branded capsules.[7]
Typical applications for pentobarbital aresedative, short termhypnotic,preanesthetic,insomnia treatment, and control ofconvulsions in emergencies.[3] Abbott Pharmaceutical discontinued manufacture of their Nembutal brand of Pentobarbital capsules in 1999, largely replaced by the benzodiazepine family of drugs.
Pentobarbital can cause death when used in high doses. It is used foreuthanasia for humans as well as animals. It is taken alone, or in combination with complementary agents such asphenytoin, in commercialanimal euthanasia injectable solutions.[5][6]
Pentobarbital sodium (CAS No. 57-33-0)
In theNetherlands, pentobarbital is part of the standard protocol forphysician-assisted suicide for self-administration by the patient.[11] It is given in liquid form, in a solution of sugar syrup andalcohol, containing 9 grams of pentobarbital. This is preceded by anantiemetic to prevent vomiting.[11]
It is taken by mouth for physician-assisted death in the United States states of Oregon, Washington, Vermont, and California (as of January 2016).[12][13] The oral dosage of pentobarbital indicated for physician-assisted suicide in Oregon is typically 10 g of liquid.[12][13]
InSwitzerland, sodium pentobarbital is administered to the patientintravenously. Once administered, sleep is induced within 30 seconds, and the heart stops beating within 3 minutes.[14] Oral administration is also used. A Swiss pharmacist reported in 2022 that the dose for assisted suicide had been raised to 15 grams because with lower doses death was preceded by a coma of up to 10 hours in some cases.[15]
Pentobarbital has been used or considered as a substitute for the barbituratesodium thiopental used forcapital punishment bylethal injection in the United States when that drug became unavailable.[16] In 2011 the U.S. manufacturer of sodium thiopental stopped production, and importation of the drug proved impossible. Pentobarbital was used in a U.S. execution for the first time in December 2010 in Oklahoma, as part of a three-drug protocol.[16] In March 2011 pentobarbital was used for the first time as the sole drug in a U.S. execution, in Ohio. Since then several states as well as the federal government have used pentobarbital for lethal injections; some use three-drug protocols and others use pentobarbital alone.
Pentobarbital is produced by the Danish companyLundbeck. Use of the drug for executions is illegal under Danish law, and when this was discovered, after public outcry in Danish media, Lundbeck stopped selling it to US states that impose thedeath penalty and prohibited US distributors from selling it to any customers, such as state authorities, that practice or participate in executions of humans.[17]
Texas began using the single-drug pentobarbital protocol for executing death-row inmates on 18 July 2012,[18] because of a shortage ofpancuronium bromide, a muscle paralytic previously used as one component of a three-drug cocktail.[18] In October 2013,Missouri changed its protocol to allow for pentobarbital from acompounding pharmacy to be used in a lethal dose for executions.[19] It was first used in November 2013.[20][21]
According to a December 2020ProPublica article, by 2017 the federalBureau of Prisons (BOP), in discussion with then Attorney GeneralJeff Sessions, had begun to search for suppliers of pentobarbital to be used in lethal injections. The BOP was aware that the use of pentobarbital as their "new drug choice" would be challenged in the courts because some lawyers had said that "pentobarbital would flood prisoners' lungs with froth and foam, inflicting pain and terror akin to a death by drowning." BOP claimed that these concerns were unjustified and that their two expert witnesses asserted that the use of pentobarbital was "humane".[22] On 25 July 2019,US Attorney GeneralWilliam Barr directed the federal government to resume capital punishment after 16 years.[23] The federal protocol provides for intravenous administration of two syringes each containing 2.5 grams of pentobarbital sodium followed by a saline flush.[24]
Like other barbiturates, pentobarbital binds to the barbiturate-binding site on theGABAA receptor. This action increases the duration of ion-channel opening. At high doses, pentobarbital is capable of opening the ion channel in the absence ofGABA.[25]
Pentobarbital is synthesized by methods analogous to that ofamobarbital, the only difference being that the alkylation of α-ethylmalonic ester is carried out with 2-bromopentane in place of 1-bromo-3-methylbutane to give pentobarbital.[27][28][29]
Pentobarbital can occur as afree acid but is usuallyformulated as the sodiumsalt, pentobarbital sodium. The free acid is only slightlysoluble in water and inethanol[30][31] while the sodium salt shows better solubility.
Pentobarbital is theINN,AAN,BAN, andUSAN whilepentobarbitone is a former AAN and BAN.
One brand name for this drug isNembutal, coined by John S. Lundy, who started using it in 1930, from the structural formula of thesodium salt—Na (sodium) +ethyl +methyl +butyl +al (commonsuffix forbarbiturates).[32] Nembutal is trademarked and manufactured by the Danish pharmaceutical companyLundbeck (now produced by Akorn Pharmaceuticals) is the only injectable form of pentobarbital approved for sale in the United States.
Nembutal capsule
Abbott discontinued its Nembutal brand of pentobarbital capsules in 1999, largely replaced by the benzodiazepine family of drugs. Abbott's Nembutal, known on the streets as "yellow jackets", was widely abused.[33][34] They were available as 30, 50, and 100 mg capsules of yellow, white-orange, and yellow colors, respectively.[35]
^abChaar B, Sami Isaac S (20 October 2017)."Euthanasia drugs: What is needed from medications for assisted deaths?".abc.net.au.Australian Broadcasting Corporation. Retrieved22 September 2021.Both secobarbital capsules and pentobarbital (usually known as the brand name, Nembutal) liquid — (not to be mistaken for epilepsy medication phenobarbital) have been used either alone or in combination for physician-assisted suicide or euthanasia. They are also used in injectable forms for animal euthanasia.
^abMartin H (13 August 2020)."Euthanasia referendum: What drugs are used in assisted dying, and how do they work?".Stuff. Retrieved22 September 2021.In Australia, most people will ingest the lethal dose of pentobarbital as a drink – a white powder mixed with about 30 millilitres of a liquid suspension. [...] However, in cases where the person is too ill to ingest the medication themselves, a doctor or nurse practitioner could administer the dose, under the proposed Act.
^Stravitz RT, Kramer AH, Davern T, Shaikh AO, Caldwell SH, Mehta RL, et al. (November 2007). "Intensive care of patients with acute liver failure: recommendations of the U.S. Acute Liver Failure Study Group".Critical Care Medicine.35 (11):2498–2508.doi:10.1097/01.CCM.0000287592.94554.5F.PMID17901832.S2CID11924124.
^Kaiserliches Patentamt German imperial patent, D.R.P. 293163 (16 July 1916), Bayer& Co
^GB patent 650354, Wilde BE, Balaban IE, "Improvements in the manufacture of substituted barbituric and thiobarbituric acids", issued 21 February 1951, assigned to Geigy
^Fosburgh LC (August 1997). "From this point in time: some memories of my part in the history of anesthesia--John S. Lundy, MD".AANA Journal.65 (4):323–328.PMID9281913.
