Barbiturates adverse effects

Baulac M, Cramer JA, Mattson RH. Phenobarbital and other barbiturates Adverse effects. In Levy RH, Mattson RH, Meldrum BS, et al, eds. Antiepileptic Drugs, 5th ed. Philadelphia, Lippincott Williams Wilkins, 2002, 528-540. 

As with the barbiturates, the most common adverse reaction seen with the use of clonazepam (Klonopin), clorazepate (Tranxene), and diazepam (Valium) is sedation in varying degrees. Additional adverse effects may include anorexia, constipation, or diarrhea. Some adverse reactions are dose dependent, whereas others may diminish in intensity or cause few problems after several weeks of therapy. 

No health hazards are known with the proper use of kava (Gruenwald et al. 1998). Kava has been approved by the German Commission E for treatment of anxiety and insomnia. In clinical studies of kava for anxiety, adverse effects were uncommon and did not differ across placebo and kava groups. There do not appear to be any studies published on the effects of acute overdosage with kava. Given its CNS depressant effects, it should not be taken with other similar drugs, including benzodiazepines, barbiturates. 

Primidone is an other second line barbiturate used orally to control tonic-clonic and partial seizures. It is a pro-drug as it is metabolized to phenobarbital and phenylethylmalonamide (PEMA), however both the parent compound as well as the metabolites have anti seizure activity. Its use is more difficult to monitor and adverse effects occur even more frequently than with phenobarbital. 

All barbiturates (except phenobarbital) except when used to control seizures Are highly addictive and cause more adverse effects than most sedative or hypnotic drugs in elderly patients. High... 

Anesthetic techniques that have minimized adverse effects include the use of muscle relaxants and, more recently, nerve stimulators to assess adequacy of relaxation, the introduction of very rapid acting, short-duration barbiturates, and the use of atropinic agents to minimize the cardiovascular response to a combination of a seizure and anesthesia (93). In addition, 100% oxygenation (adequacy monitored by a pulse oximeter) with positive-pressure ventilation can minimize related cardiac events and memory disruption. 

Barbiturates reduce hepatic blood flow and glomerular filtration rate, but these drugs produce no adverse effects on hepatic or renal function. Barbiturates can exacerbate acute intermittent porphyria by inducing the production of hepatic ct -aminolevulinic acid (ALA) synthase (see Chapter 22). On rare occasions, thiopental has precipitated porphyric crisis when used as an induction agent in susceptible patients. 

T effects OF amiodarone, astemizole, atorvastadn, barbiturates, bepridil, bupropion, cerivastatin, cisapride, clorazepate, clozapine, clarithromycin, desipramine, diazepam, encainide, ergot alkaloids, estazolam, flecainide, flurazepam, indinavir, ketoconazole, lovastatin, meperidine, midazolam, nelfinavir, phenytoin, pimozide, piroxicam, propafenone, propoxyphene, quinidine, rifabutin, saquinavir, sildenafil, simvastatin, SSRIs, TCAs, terfenadine, triazolam, troleandomycin, zolpidem X effects W/ barbiturates, carbamazepine, phenytoin, rifabutin, rifampin, St. John s wort, tobacco X effects OF didanosine, hypnotics, methadone, OCPs, sedatives, theophylline, warfarin EMS T Effects of amiodarone, diazepam, midazolam and BBs, may need X- doses concurrent use of Viagra-type drugs can lead to hypotension X- effects of warfarin concurrent EtOH use can T adverse effects T glucose ODs May cause an extension of adverse SEs symptomatic and supportive Rivasrigmine (Exelon) [Cholinesterase Inhibitor/Anri ... 

The barbiturates and meprobamate have been entirely superseded by the benzodiazepines and because of their low benefit-to-risk ratio (dependence producing, lethality in overdose, potent sedative effects) they should never be used as anxiolytics. Despite their popularity as short-term sedatives, antihistamines are ineffective anxiolytics, while the use of sedative antidepressants such as amitriptyline should be limited to the treatment of patients with symptoms of both anxiety and depression due to their limited efficacy and the poor patient compliance associated with their adverse effects. However, patients with panic disorder do appear to show a beneficial response to antidepressants (see Chapter 6). A similar argument... 

Barbiturates are also present in high concentrations in the breast milk of women who take them. Infants who consume this breast milk may experience side effects like excess sleepiness and lethargy. They may also experience withdrawal symptoms when weaned from breast milk. Long-term adverse effects of infant exposure to barbiturates in breast milk have not been well documented. However, the American Academy of Pediatrics cautions against breast-feeding while taking barbiturates because there may be risks to the infant. 

Pentozocine Lactate Injections of pentozocine lactate are incompatible with sodium bicarbonate, barbiturates, diazepam, chlordiazepoxide, glycopyrronium bromide, and nafcillin sodium. Dependence, withdrawal, and treatment of adverse effects are generally similar to those of opioid analgesics. 

MAOIs interact with sympathomimetics, barbiturates, hypoglycemics, antimus-carinics, alcohol, antihypertensives, and antidepressants. Care must be exercised during concomitant administration. Since adverse effects may be seen after a long period, patients must be monitored carefully, even after therapy.144... 

Picrotoxin is a non-nitrogenous plant derivative that is a powerful stimulant of all parts of the central nervous system, acting on the chloride ionophore-aminobutyric acid complex in a manner opposite to that of barbiturates (1). Its adverse effects resemble those of nikethamide picrotoxin 20mg can cause severe poisoning. 

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