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Pentobarbital Dosage

Applies to the following strength(s): 50 mg/mL ; 100 mg ; 18.2 mg/5 mL ; 120 mg ; 60 mg ; 50 mg ; 200 mg ; 30 mg ; sodium

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Insomnia

Oral capsules or elixir: 100 mg orally at bedtime.
Rectal suppository: 120 to 200 mg rectally.
Injection: 100 to 200 mg IM or IV.

Usual Adult Dose for Sedation

Oral capsules or elixir: 100 mg orally at bedtime.
Rectal suppository: 120 to 200 mg rectally.
Injection: 100 to 200 mg IM or IV.

Usual Pediatric Dose for Sedation

Procedural (moderate) sedation:

Oral:
Infants: 4 mg/kg orally followed by 2 to 4 mg/kg every 30 minutes if needed
Maximum dose: 8 mg/kg orally

Infants and Children:
IM: 2 to 6 mg/kg
IM Maximum dose: 100 mg
IV: Initial 1 to 2 mg/kg; additional doses of 1 to 2 mg/kg every 3 to 5 minutes to desired effect; usual effective total dose is 1 to 6 mg/kg
IV Maximum dose: 100 mg/dose Note: Patients receiving concurrent barbiturate therapy may require higher total mg/kg doses (up to 9 mg/kg).

Children:
Oral, Rectal:
Less than 4 years: 3 to 6 mg/kg
Maximum dose: 100 mg
Greater than or equal to 4 years: 1.5 to 3 mg/kg
Maximum dose: 100 mg

Adolescents: IV: 100 mg prior to procedure

Reduction of elevated ICP:
IV: Note: Intubation is required; dose should be adjusted based on hemodynamics, ICP, cerebral perfusion pressure, and EEG.
Low dose: Children and Adolescents: 5 mg/kg every 4 to 6 hours
High-dose pentobarbital coma: Children and Adolescents: Loading dose: 10 mg/kg over 30 minutes, then 5 mg/kg every hour for 3 hours; initial maintenance infusion: 1 mg/kg/hour; adjust to maintain burst suppression on EEG; maintenance dose range: 1 to 2 mg/kg/hour

Sedation of mechanically ventilated ICU patient (who failed standard therapy):
IV: Infants, Children, and Adolescents: Loading dose: 1 mg/kg followed by 1 mg/kg/hour infusion. Additional boluses at a dose equal to hourly rate may be given every 2 hours as needed. If greater than or equal to 4 to 6 boluses are administered within 24 hours, then increase maintenance rate by 1 mg/kg/hour; reported required range: 1 to 6 mg/kg/hour (median: 2 mg/kg/hour). Tapering of dose and/or conversion to oral phenobarbital has been reported for therapy greater than or equal to 5 days.

Usual Pediatric Dose for Status Epilepticus

Status epilepticus refractory to standard therapy:
Note: Intubation is required; dose should be adjusted based on hemodynamics, seizure activity, and EEG.

IV:
Infants, Children, and Adolescents:
Loading dose: 5 mg/kg
Maintenance infusion: Initial: 1 mg/kg/hour, may increase up to 3 mg/kg/hour (usual range: 1 to 3 mg/kg/hour); maintain burst suppression on EEG for 12 to 48 hours (no seizure activity), tapering pentobarbital rate by 0.5 mg/kg every 12 hours has been reported.

High-dose pentobarbital coma:
IV:
Infants and Children: Loading dose: 10 to 15 mg/kg given slowly over 1 to 2 hours; monitor blood pressure and respiratory rate.
Maintenance infusion: Initial: 1 mg/kg/hour; may increase up to 5 mg/kg/hour (usual range: 0.5 to 3 mg/kg/hour); maintain burst suppression on EEG.
Note: Loading doses of 20 to 35 mg/kg (given over 1 to 2 hours) have been utilized in pediatric patients for pentobarbital coma, but these higher loading doses often cause hypotension requiring vasopressor therapy.

Renal Dose Adjustments

Dosage should be reduced for patients with impaired renal function.

Liver Dose Adjustments

Dosage should be reduced for patients with hepatic disease.

Dose Adjustments

Dosage should be reduced in the elderly or debilitated because these patients may be more sensitive to barbiturates.

Dialysis

Data not available

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