APROBARBITAL (a-pro-bar'bi-tol) Alurate Classifications: central nervous system agent; anxiolytic, sedative-hypnotic; barbiturate Prototype: Secobarbital Pregnancy Category: D
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40 mg/5 mL elixir
Intermediate-acting barbiturate. These agents depress the sensory cortex, decrease motor activity, alter cerebellar function,
and produce drowsiness, sedation, and hypnosis. Barbiturates have little analgesic action at subanesthetic doses and may increase
the reaction to painful stimuli. All barbiturates exhibit anticonvulsant activity in anesthetic doses.
Barbiturates can produce all levels of CNS mood alteration, from excitation to mild sedation, hypnosis, and deep coma. Barbiturates
are respiratory depressants; the degree of respiratory depression is dose dependent. With hypnotic doses, respiratory depression
is similar to that which occurs during physiologic sleep.
Indicated for routine sedation and as a hypnotic in the short-term treatment of insomnia for up to 2 wk. Barbiturates seem
to lose their efficacy for sleep induction and maintenance after this period of time.
Barbiturate hypersensitivity; history of manifest or latent porphyria; impaired liver function; impaired renal function; severe
respiratory distress, respiratory disease where dyspnea, obstruction, or cor pulmonale is present; previous addiction to the
sedative-hypnotic group; acute or chronic pain. Safety during pregnancy (category D), lactation, or in children is not established.
Older adults or debilitated patients, presence of fever, hyperthyroidism, diabetes mellitus, severe anemia, debility, severely
impaired liver function, pulmonary or cardiac disease, status asthmaticus, shock, uremia, borderline hypoadrenal function.
Sedative Adult: PO 40 mg t.i.d.
Hypnotic Adult: PO 40160 mg
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Oral
- Determine if lower initial dose should be used in patient with impaired renal or hepatic function.
- Determine if an increase in dosage is needed for patient on dialysis.
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Note: Not to be used on prolonged basis; demonstrated effectiveness is only 2 wk.
- Store away from heat and direct light in airtight container at 15°30° C (59°86° F).
CNS:
Somnolence, agitation, confusion, hyperkinesia, ataxia, vertigo, CNS depression, nightmares, lethargy, residual sedation (hangover effect), paradoxical excitement, nervousness, psychiatric disturbance, hallucinations, insomnia, anxiety, dizziness, thinking abnormalities,
delirium and stupor with excessive amounts. CV: Bradycardia, circulatory collapse, hypotension, syncope. GI: Nausea, vomiting, constipation, diarrhea, epigastric pain. Hematologic:
Agranulocytosis (rare). Respiratory: Hypoventilation, apnea, respiratory depression, laryngospasm, bronchospasm.
barbiturates may cause a false-positive phentolamine test and decrease serum bilirubin concentrations.
Drug:
cns depressants, alcohol,
sedatives compound CNS depression; mao inhibitors cause excessive CNS depression; anticonvulsants, rifampin,
phenmetrazine may decrease effects of aprobarbital. Herbal:
Kava-kava,
valerian may potentiate sedation.
Absorption: Well absorbed from GI tract. Onset: 4560 min. Duration: 3 h. Distribution: Crosses placenta; distributed into breast milk. Metabolism: Metabolized in the liver. Elimination: Excreted in urine. Half-Life: 1440 h.
Assessment & Drug Effects
- Monitor for severe drowsiness, severe confusion, severe weakness, shortness of breath, slow or troubled breathing, slurred
speech, staggering gait, and bradycardia.
- Lab tests: Monitor hematologic studies for blood dyscrasia; monitor liver function studies with continuous or prolonged use.
- Monitor older adults for paradoxical response (i.e., irritability, marked excitement, depression, and confusion).
- Monitor phenytoin and barbiturate blood levels frequently if given concurrently because the effect of barbiturates on metabolism
is unpredictable.
Patient & Family Education
- Do not increase the dose of the drug without consulting a physician.
- Avoid use of alcohol or other CNS depressants.
- Do not drive or engage in potentially hazardous tasks until response to drug is known.
- Notify physician if any of the following occurs: fever, sore throat, mouth sores, easy bruising or bleeding, nosebleed, or
petechiae.
- Do not discontinue use of medication abruptly; physician may want to taper dosage to avoid possibility of withdrawal symptoms.
- Check with physician for suspected psychological or physical dependence.
- Increase vitamin Dfortified foods (e.g., milk products); drug increases vitamin D metabolism, leading to subtherapeutic
levels and possible onset of osteomalacia or rickets.
- Do not breast feed while taking this drug without consulting physician.