GLUTETHIMIDE
(gloo-teth'i-mide)
Doriglute
Classifications: central nervous system agent; anxiolytic; sedative-hypnotic
Prototype: Secobarbital
Pregnancy Category: C
Controlled Substance: Schedule III

Availability

250 mg tablets

Actions

Pharmacologic actions similar to those of barbiturates. Can induce hypnosis without producing reliable analgesic, antitussive, or anticonvulsant action. Causes less respiratory depression but greater degree of hypotension than barbiturates. Addiction liability similar to that of barbiturates.

Therapeutic Effects

Significantly suppresses REM sleep; but following drug withdrawal after chronic administration, REM rebound occurs, and patient may experience markedly increased dreaming, nightmares, insomnia.

Uses

Short-term treatment of insomnia and for sedative effect preoperatively and during first stage of labor. Not indicated for routine sedation or persistent insomnia.

Contraindications

Uncontrolled pain; intermittent porphyria; severe hepatic and renal impairment; prolonged administration; lactation; children <12 y. Safe use during pregnancy [(category C) except with caution during first stage of labor] is not established.

Cautious Use

Older adult or debilitated patients; prostatic hypertrophy, bladder neck obstruction; pyloroduodenal obstruction, stenosing peptic ulcer; narrow-angle glaucoma; hypotension, cardiac arrhythmias; mental depression (particularly in patients with suicidal tendencies), history of alcoholism or drug abuse.

Route & Dosage

Insomnia
Adult: PO 250–500 mg h.s., may repeat prn but not <4 h before arising

Preoperative Sedation
Adult: PO 500 mg the night before surgery and 500 mg–1 g 1 h before anesthesia

Administration

Oral

Adverse Effects (1%)

Body as a Whole: Acute hypersensitivity reactions. CNS: CNS depression in fetus; paradoxic excitement, headache, vertigo. GI: Gastric irritation, nausea, drug "hangover," dry mouth. Hematologic: Blood dyscrasias. Skin: Generalized skin rash (occasionally, purpuric or urticarial), exfoliative dermatitis (rare). Other: Hiccups, blurred vision. Acute Overdosage: CNS depression (coma; depressed reflexes, including corneal reflex; dilated, fixed pupils; hypotension; hypothermia followed by hyperpyrexia; tachycardia; respiratory depression, cyanosis, sudden apnea; decreased intestinal motility, adynamic ileus; facial twitching; intermittent spasticity; flaccid paralysis; pulmonary and cerebral edema; renal tubular necrosis; severe infections). Chronic Ingestion: Toxic psychosis (slurred speech, impaired memory, inability to concentrate, mydriasis, dry mouth, nystagmus, ataxia, hyporeflexia, tremors, peripheral neuropathy).

Interactions

Drug: Alcohol, barbiturates, other cns depressants compound depressant effects; tricyclic antidepressants add to anticholinergic effects; decreases anticoagulant effects of oral anticoagulants.

Pharmacokinetics

Absorption: Erratic absorption from GI tract. Onset: 30 min. Duration: 4–8 h. Distribution: Widely distributed; localizes in adipose tissue, liver, kidney, brain, and bile; crosses placenta; distributed into breast milk in small quantities. Metabolism: Metabolized in liver. Elimination: Metabolites excreted in urine. Half-Life: 10–12 h.

Nursing Implications

Assessment & Drug Effects

Patient & Family Education


Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug