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 Vol. 18 No. 8, August 1997
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(Pediatrics in Review. 1997;18:260-265.)
© 1997 American Academy of Pediatrics

Barbiturates

Susan M. Coupey, MD*
* Professor of Pediatrics, Albert Einstein College of Medicine; Associate Director, Division of Adolescent Medicine, Montefiore Medical Center, Bronx, NY.


   IMPORTANT POINTS
 

  1. Barbiturates are sedative/hypnotic drugs with a narrow therapeutic index between sedation and coma or death.
  2. Short-acting barbiturates have a high potential for abuse, are physiologically addicting, and are associated with a life-threatening abstinence syndrome.
  3. Barbiturates freely cross the placenta, resulting in neonatal addiction if taken by the mother regularly during the third trimester of pregnancy.
  4. Illicit use of barbiturates by adolescents has increased gradually during the 1990s, with slightly more than 7% of high school seniors reporting having used this class of drug in 1995.
  5. Most illicit use of barbiturates is in the context of multiple drug abuse and is sporadic; thus, addiction is very uncommon.
  6. Overdose of short-acting barbiturates can be lethal even with intensive therapy because the drugs are highly protein-bound and not readily dialyzed.


   Introduction
 
Barbiturates are classified as sedative/hypnotics because of their central nervous system depressant and sleep-inducing effects. They were used first in medical practice in the early 1900s; phenobarbital was introduced in 1912. This long-acting barbiturate still is prescribed for children and adolescents who have seizure disorders. The primary medical uses for barbiturates are as anesthetic and anticonvulsant agents. In addition, amobarbital and methohexital are used in diagnostic testing for psychiatric and epileptiform disorders. All barbiturates are physiologically addicting and have the potential for producing a life-threatening abstinence syndrome. The abuse of barbiturates, both prescription and illicit, peaked in the early 1970s. By the mid-1980s, treatment of anxiety and insomnia was accomplished primarily with the much safer benzodiazepine class of drugs. As the number of prescriptions written for barbiturates decreased dramatically, so did abuse.

Illicitly obtained barbiturates are used to reduce anxiety, decrease inhibitions, and treat unwanted effects of stimulants and other illicit drugs (Table 1Go ). Short-acting barbiturates such as secobarbital or pentobarbital are preferred for these purposes. Some street names for barbiturates reflect . . . [Full Text of this Article]






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Copyright © 1997 by the American Academy of Pediatrics.