Brevital Sodium Dosage

Generic name: METHOHEXITAL SODIUM 500mg
Dosage form: injection, powder, lyophilized, for solution
Drug class: General anesthetics

Medically reviewed by Drugs.com. Last updated on Jan 22, 2024.

Facilities for assisting ventilation and administering oxygen are necessary adjuncts for all routes of administration of anesthesia. Since cardiorespiratory arrest may occur, patients should be observed carefully during and after use of BREVITAL. Age- and size- appropriate resuscitative equipment (i.e., intubation and cardioversion equipment, oxygen, suction, and a secure intravenous line) and personnel qualified in its use must be immediately available.

Preanesthetic medication is generally advisable. BREVITAL may be used with any of the recognized preanesthetic medications.

Preparation of Solution

FOLLOW DILUTION INSTRUCTIONS EXACTLY.

Freshly prepare solutions of BREVITAL and use promptly. Reconstituted solutions of BREVITAL are chemically stable at room temperature for 24 hours.

Diluents

ONLY USE BACTERIOSTATIC-FREE DILUENT – Recommended diluents are based on route of administration (see Dilution Instructions).

Incompatible diluents: Lactated Ringer’s Injection

Dilution Instructions

1% solutions (10 mg/mL) should be prepared for intermittent intravenous and rectal administration; 0.2% solutions (2 mg/mL) should be prepared for continuous intravenous drug administration; 5% solutions (50 mg/mL) should be prepared for intramuscular administration.

Contents of vials should be diluted as follows:

FOR INTERMITTENT INTRAVENOUS and RECTAL ADMINISTRATION

The preferred diluent for intermittent intravenous and rectal administration is Sterile Water for Injection. 5% Dextrose Injection, or 0.9% Sodium Chloride Injection are also acceptable diluents.

Strength	Amount of Diluent to Be Added to the Contents of the BREVITAL Vial	For 1% methohexital solution (10 mg/mL)
500 mg	50 mL	no further dilution needed

FOR CONTINUOUS INTRAVENOUS ADMINISTRATION

For continuous drip anesthesia, prepare a 0.2% solution by adding 500 mg of Brevital Sodium to 250 mL of diluent. For this dilution, either 5% glucose solution or isotonic (0.9%) sodium chloride solution ONLY is recommended as the diluent instead of sterile water for injection in order to avoid extreme hypotonicity.

Strength	Amount of Diluent to Be Added to the Contents of the BREVITAL Vial	For 0.2% methohexital solution (2 mg/mL)
500 mg	15 mL	add to 235 mL diluent for 250 mL total volume

FOR INTRAMUSCULAR ADMINISTRATION

The preferred diluent for intramuscular administration is Sterile Water for Injection. 0.9% Sodium Chloride Injection is also an acceptable diluent.

Strength	Amount of Diluent to Be Added to the Contents of the BREVITAL Vial	For 5% methohexital solution (50 mg/mL)
500 mg	10 mL	no further dilution needed

Administration

Dosage is highly individualized; the drug should be administered only by those completely familiar with its quantitative differences from other barbiturate anesthetics.

Adults

BREVITAL Sodium is administered intravenously in a concentration of no higher than 1%. Higher concentrations markedly increase the incidence of muscular movements and irregularities in respiration and blood pressure.

Induction of anesthesia

For induction of anesthesia, a 1% solution is administered at a rate of about 1 mL/5 seconds. Gaseous anesthetics and/or skeletal muscle relaxants may be administered concomitantly. The dose required for induction may range from 50 to 120 mg or more but averages about 70 mg. The usual dosage in adults ranges from 1 to 1.5 mg/kg. The induction dose usually provides anesthesia for 5 to 7 minutes.

Maintenance of anesthesia

Maintenance of anesthesia may be accomplished by intermittent injections of the 1% solution or, more easily, by continuous intravenous drip of a 0.2% solution. Intermittent injections of about 20 to 40 mg (2 to 4 mL of a 1% solution) may be given as required, usually every 4 to 7 minutes. For continuous drip, the average rate of administration is about 3 mL of a 0.2% solution/minute (1 drop/second). The rate of flow must be individualized for each patient. For longer surgical procedures, gradual reduction in the rate of administration is recommended (see discussion of prolonged administration in WARNINGS). Other parenteral agents, usually narcotic analgesics, are ordinarily employed along with BREVITAL during longer procedures.

Pediatric Patients

BREVITAL is administered intramuscularly in a 5% concentration and administered rectally as a 1% solution.

Induction of anesthesia

For the induction of anesthesia by the intramuscular route of administration, the usual dose ranges from 6.6 to 10 mg/kg of the 5% concentration. For rectal administration, the usual dose for induction is 25 mg/kg using the 1% solution.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.

Compatibility Information

Solutions of BREVITAL should not be mixed in the same syringe or administered simultaneously during intravenous infusion through the same needle with acid solutions, such as atropine sulfate, metocurine iodide, and succinylcholine chloride. Alteration of pH may cause free barbituric acid to be precipitated. Solubility of the soluble sodium salts of barbiturates, including BREVITAL Sodium, is maintained only at a relatively high (basic) pH.

Because of numerous requests from anesthesiologists for information regarding the chemical compatibility of these mixtures, the following chart contains information obtained from compatibility studies in which a 1% solution of BREVITAL was mixed with therapeutic amounts of agents whose solutions have a low (acid) pH.

Active Ingredient	Potency per mL	Volume Used	Immediate	15 min	Physical Change 30 min	1 h
BREVITAL	10 mg	10 mL			CONTROL
Atropine Sulfate	1/150 gr	1 mL	None	Haze
Atropine Sulfate	1/100 gr	1 mL	None	Ppt	Ppt
Succinylcholine chloride	0.5 mg	4 mL	None	None	Haze
Succinylcholine chloride	1 mg	4 mL	None	None	Haze
Metocurine Iodide	0.5 mg	4 mL	None	None	Ppt
Metocurine Iodide	1 mg	4 mL	None	None	Ppt
Scopolamine hydrobromide	1/120 gr	1 mL	None	None	None	Haze
Tubocurarine chloride	3 mg	4 mL	None	Haze