{"id":184,"date":"2025-03-04T14:55:01","date_gmt":"2025-03-04T14:55:01","guid":{"rendered":"https:\/\/euthanasiasleep.com\/?post_type=product&p=184"},"modified":"2026-04-19T15:48:49","modified_gmt":"2026-04-19T15:48:49","slug":"nembutal-oral-solution","status":"publish","type":"product","link":"https:\/\/euthanasiasleep.com\/fr\/produit\/nembutal-oral-solution\/","title":{"rendered":"Nembutal solution orale"},"content":{"rendered":"
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\u00a0 Solution orale de Nembutal Dose de Lathal pour l'euthanasie<\/p>\n

Phenobarbital Oral Solution Description<\/strong><\/h2>\n

 <\/p>\n

Barbiturates are nonselective central nervous system (CNS) depressants that are primarily used as sedative-hypnotics. In subhypnotic doses, they are also used as anticonvulsants. Barbiturates and their sodium salts are subject to control under the Federal Controlled Substances Act. Phenobarbital is a barbituric acid derivative and occurs as white, odorless, small crystals or crystalline powder that is very slightly soluble in water; soluble in alcohol, in ether, and solutions of fixed alkali hydroxides and carbonates; and sparingly soluble in chloroform. Phenobarbital is 5-ethyl-5-phenylbarbituric acid and has the empirical formula C 12H 12N 2O 3. Its molecular weight is 232.24. It has the following structural formula: Pentobarbital oral solution (PB) is a euthanasia drug in doses of 2 to 10 grams, causing death within 15\u201330 minutes. We report a case of recovery from lethal pentobarbital deliberate self-poisoning with confirmatory serum drug concentrations.<\/p>\n

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Rapport de cas<\/h3>\n

Un homme de 45 ans a achet\u00e9 20 grammes de poudre de PB sur Internet. Il a ing\u00e9r\u00e9 cette poudre et a alert\u00e9 sa m\u00e8re 10 minutes plus tard. Celle-ci l'a trouv\u00e9 sans r\u00e9action et a commenc\u00e9 la r\u00e9animation cardio-pulmonaire (RCP). Dans les 20 minutes suivant l'ingestion, les services m\u00e9dicaux d'urgence sont arriv\u00e9s et ont commenc\u00e9 les soins avanc\u00e9s de r\u00e9animation. \u00c0 son arriv\u00e9e au service des urgences, son rythme cardiaque \u00e9tait de 116 bpm, sa tension art\u00e9rielle de 117\/62 mmHg et il \u00e9tait sous perfusion d'adr\u00e9naline. Il \u00e9tait hypotonique et hypothermique, et ses r\u00e9flexes du tronc c\u00e9r\u00e9bral \u00e9taient absents. L'ECG et le scanner c\u00e9r\u00e9bral \u00e9taient normaux. Du charbon actif lui a \u00e9t\u00e9 administr\u00e9 et il a \u00e9t\u00e9 admis en soins intensifs. Il est rest\u00e9 comateux avec absence de r\u00e9flexes du tronc c\u00e9r\u00e9bral jusqu'au 5e jour. L'angiographie c\u00e9r\u00e9brale du jour 3 \u00e9tait normale. Les analyses d'urine qualitatives ont d\u00e9tect\u00e9 du pentobarbital, ce qui sugg\u00e8re que les effets m\u00e9dicamenteux en cours sont \u00e0 l'origine du coma. Il a \u00e9t\u00e9 extub\u00e9 le 10e jour et s'est compl\u00e8tement r\u00e9tabli. Deux heures et demie apr\u00e8s l'ingestion, la concentration de PB \u00e9tait de 112 mg\/L ; le PB a atteint un pic de 116 mg\/L \u00e0 29 heures ; le PB \u00e9tait de 2 mg\/L \u00e0 190 heures et ind\u00e9tectable plus de 200 heures apr\u00e8s l'ingestion.<\/p>\n<\/section>\n

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Discussion<\/h3>\n

La concentration moyenne de PB chez les personnes d\u00e9c\u00e9d\u00e9es serait d'environ 30 mg\/L. Ce patient a surv\u00e9cu \u00e0 des concentrations s\u00e9riques plus \u00e9lev\u00e9es gr\u00e2ce \u00e0 une r\u00e9animation cardio-pulmonaire pr\u00e9coce et \u00e0 une assistance cardio-respiratoire prolong\u00e9e aux soins intensifs. L'\u00e9valuation de la mort du tronc c\u00e9r\u00e9bral doit \u00eatre report\u00e9e jusqu'\u00e0 ce que le PB ait \u00e9t\u00e9 correctement \u00e9limin\u00e9.<\/p>\n<\/section>\n

\u00a0Barbiturates, Pentobarbital, Nembutal, Overdose, Poisoning, Cardiac arrest<\/section>\n
<\/section>\n<\/section>\n
\n

Le pentobarbital (Nembutal) est un s\u00e9datif-hypnotique barbiturique \u00e0 courte dur\u00e9e d'action largement utilis\u00e9 dans la pratique v\u00e9t\u00e9rinaire pour l'anesth\u00e9sie et l'euthanasie. Il est \u00e9galement recommand\u00e9 comme m\u00e9dicament pour l'euthanasie ou le suicide assist\u00e9 en raison de l'apparition rapide du coma et de la perception d'une mort paisible. Le fait que les m\u00e9dias populaires rapportent que le pentobarbital est une m\u00e9thode de suicide pacifique a suscit\u00e9 un int\u00e9r\u00eat accru pour son obtention dans des juridictions o\u00f9 il est moins r\u00e9glement\u00e9 [1<\/a>]. Il est peu probable que des mesures de r\u00e9animation soient prises dans ces circonstances.<\/p>\n

Nous rapportons un cas de survie \u00e0 la suite d'un auto-empoisonnement d\u00e9lib\u00e9r\u00e9 avec un produit potentiellement dangereux pour la sant\u00e9. dose l\u00e9tale<\/a> de pentobarbital obtenu via Internet, chez un patient qui a regrett\u00e9 ses actes et a demand\u00e9 de l'aide presque imm\u00e9diatement. Les concentrations s\u00e9riques de m\u00e9dicaments confirm\u00e9es sont pr\u00e9sent\u00e9es dans le contexte de l'\u00e9volution clinique du patient.<\/p>\n<\/section>\n

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<\/a>Histoire de cas<\/h2>\n

A 45-year-old male impulsively ingested 20 grams of pentobarbital<\/a> (Nembutal) that he had purchased via the Internet from a source overseas 2 years previously. He had a history of bipolar affective disorder, trigeminal neuralgia, and chronic pain. His regular medications included venlafaxine, gabapentin, and asenapine. He alerted his mother 10 minutes after taking the overdose. She immediately contacted emergency medical services (EMS). When she returned to him, he was on the floor and unconscious, and she immediately commenced cardiopulmonary resuscitation (CPR). EMS arrived 10 minutes after the call (approximately 20 minutes post-ingestion) and found him to be in a pulseless electrical activity cardiac arrest. CPR continued, and advanced life support (ALS) measures were commenced. He received two intravenous doses of 1 mg epinephrine during initial resuscitation, with return of spontaneous circulation (ROSC) occurring after 10 min. The patient was intubated and ventilated. He had a further brief cardiac arrest 30 minutes later, with ROSC being achieved after another 2 minutes of CPR and a further 1 mg epinephrine. He was commenced on an epinephrine infusion at 100 \u03bcg\/min, given a 500-mL normal saline bolus, and transported to the emergency department (ED).<\/p>\n

Le patient est arriv\u00e9 aux urgences 95 minutes apr\u00e8s l'appel initial aux services m\u00e9dicaux d'urgence. Lors de sa pr\u00e9sentation, il \u00e9tait inconscient (GCS 3\/15) sans s\u00e9dation suppl\u00e9mentaire, avait des pupilles fixes dilat\u00e9es, \u00e9tait en apn\u00e9e sous respirateur et n'avait pas de r\u00e9flexes au niveau du tronc c\u00e9r\u00e9bral. Il \u00e9tait en hypothermie (33,8 \u00b0C). La fr\u00e9quence cardiaque \u00e9tait de 116 bpm et la tension art\u00e9rielle de 117\/62 mmHg sous perfusion d'adr\u00e9naline \u00e0 100\u03bcg\/min. Les gaz du sang veineux indiquaient un pH de 7,02, une pCO2<\/sub>\u00a060 mmHg, HCO3<\/sub> 15 mmol\/L, and 11.9 mmol\/L lactate. Serum ethanol, paracetamol, and salicylate were undetectable. ECG was unremarkable,e and CT brain revealed no acute abnormality. A single dose of 50 g activated charcoal was administered via NGT and he was admitted to the ICU.<\/p>\n

Il a \u00e9t\u00e9 d\u00e9cid\u00e9 de lui administrer un traitement de soutien et de ne pas mettre en place de techniques d'\u00e9limination extracorporelle. Le premier jour aux soins intensifs, il a d\u00e9velopp\u00e9 une polyurie, avec un d\u00e9bit urinaire atteignant 300 ml\/h, et une hypernatr\u00e9mie (Na s\u00e9rique 149 mmol\/L), il a donc \u00e9t\u00e9 trait\u00e9 avec une dose de desmopressine.<\/p>\n

Il a n\u00e9cessit\u00e9 un soutien vasopresseur par perfusion de noradr\u00e9naline (dose maximale de 30 \u03bcg\/min) pendant les 5 premiers jours de son admission. Il est rest\u00e9 comateux sans s\u00e9dation, avec des r\u00e9flexes du tronc c\u00e9r\u00e9bral absents, ce qui a suscit\u00e9 des discussions sur le diagnostic de mort c\u00e9r\u00e9brale. Une angiographie c\u00e9r\u00e9brale \u00e0 quatre vaisseaux a \u00e9t\u00e9 r\u00e9alis\u00e9e le 3e jour. Elle a montr\u00e9 une perfusion c\u00e9r\u00e9brale normale. L'urine envoy\u00e9e pour une analyse qualitative par chromatographie en phase gazeuse et spectrom\u00e9trie de masse (GC-MS) a d\u00e9tect\u00e9 du pentobarbital, confirmant que les effets m\u00e9dicamenteux en cours \u00e9taient la cause probable du coma persistant. Le cinqui\u00e8me jour, on a constat\u00e9 un retour du r\u00e9flexe naus\u00e9eux lors de l'aspiration et l'ouverture des yeux \u00e0 des stimuli douloureux. Une perfusion de propofol a \u00e9t\u00e9 mise en place pour permettre la tol\u00e9rance \u00e0 la sonde endotrach\u00e9ale \u00e0 partir du 7e jour. Cependant, l'extubation a \u00e9t\u00e9 retard\u00e9e en raison de l'apparition d'une pneumopathie d'aspiration. Il a finalement \u00e9t\u00e9 extub\u00e9 le 10e jour apr\u00e8s le surdosage et a \u00e9t\u00e9 renvoy\u00e9 dans le service m\u00e9dical le lendemain. Il a d\u00fb rester 10 jours de plus \u00e0 l'h\u00f4pital pour le traitement continu de sa pneumopathie d'aspiration et la physioth\u00e9rapie pour le reconditionnement. Il s'est compl\u00e8tement r\u00e9tabli sur le plan neurologique et a confirm\u00e9 l'ingestion de 20 grammes de poudre de pentobarbital m\u00e9lang\u00e9e \u00e0 de l'eau. Il a \u00e9t\u00e9 transf\u00e9r\u00e9 dans un \u00e9tablissement psychiatrique le 22e jour apr\u00e8s l'overdose. Il y est rest\u00e9 hospitalis\u00e9 pendant trois semaines suppl\u00e9mentaires avant d'\u00eatre renvoy\u00e9 chez lui, tout en b\u00e9n\u00e9ficiant d'un suivi psychiatrique ambulatoire.<\/p>\n

Les concentrations s\u00e9riques s\u00e9rielles de pentobarbital ont \u00e9t\u00e9 dos\u00e9es r\u00e9trospectivement par chromatographie liquide \u00e0 haute performance\/spectrom\u00e9trie de masse (HPLC\/MS) et sont r\u00e9sum\u00e9es dans la Fig.\u00a01<\/a>. La concentration maximale \u00e9tait de 116 mg\/ml environ 29 heures apr\u00e8s l'ingestion (taux th\u00e9rapeutique de 1,8 \u00e0 4,7 mg\/l).<\/p>\n

\n

Fig. 1.<\/h3>\n

\"Fig.<\/a><\/p>\n

<\/div>
Concentrations s\u00e9riques de pentobarbital en s\u00e9rie et temps apr\u00e8s l'ingestion. La ligne pointill\u00e9e inf\u00e9rieure repr\u00e9sente la concentration \u00e0 laquelle une s\u00e9dation profonde est g\u00e9n\u00e9ralement observ\u00e9e (10 mg\/L). La ligne pointill\u00e9e sup\u00e9rieure repr\u00e9sente la concentration l\u00e9tale moyenne (30 mg\/L).<\/figcaption><\/figure>\n

Le consentement \u00e9crit pour la publication de ce cas a \u00e9t\u00e9 obtenu et fourni au journal.<\/p>\n<\/section>\n

\n
\n

Phenobarbital Oral Solution – Clinical Pharmacology<\/h2>\n

Barbiturates are capable of producing all levels of CNS mood alteration, from excitation to mild sedation, hypnosis, and deep coma. Overdosage can produce death. In high enough therapeutic doses, barbiturates induce anesthesia.<\/p>\n

Les barbituriques d\u00e9priment le cortex sensoriel, diminuent l'activit\u00e9 motrice, alt\u00e8rent la fonction c\u00e9r\u00e9belleuse et provoquent la somnolence, la s\u00e9dation et l'hypnose.<\/p>\n

Barbiturate-induced sleep differs from physiologic sleep. Sleep laboratory studies have demonstrated that barbiturates reduce the amount of time spent in the rapid eye movement (REM) phase of sleep or the dreaming stage. Also, in Stages III and IV, sleep is decreased. Following abrupt cessation of barbiturates used regularly, patients may experience markedly increased dreaming, nightmares, and\/or insomnia. Therefore, withdrawal of a single therapeutic dose over 5 or 6 days has been recommended to lessen the REM rebound and disturbed sleep that contribute to the drug withdrawal syndrome (for example, the dose should be decreased from 3 to 2 doses\/day for 1 week).<\/p>\n

In studies, secobarbital sodium and pentobarbital sodium have been found to lose most of their effectiveness for both inducing and maintaining sleep by the end of 2 weeks of continued drug administration, even with the use of multiple doses. As with secobarbital sodium and pentobarbital sodium, other barbiturates (including amobarbital) might be expected to lose their effectiveness for inducing and maintaining sleep after about 2 weeks. The short-, intermediate-, and, to a lesser degree, long-acting barbiturates have been widely prescribed for treating insomnia. Although the clinical literature abounds with claims that the short-acting barbiturates are superior for producing sleep whereas the intermediate-acting compounds are more effective in maintaining sleep, controlled studies have failed to demonstrate these differential effects. Therefore, as sleep medications, barbiturates are of limited value beyond short-term use.<\/p>\n

Barbiturates have little analgesic action at subanesthetic doses. Rather, in subanesthetic doses, these drugs may increase the reaction to painful stimuli. All barbiturates exhibit anticonvulsant activity in anesthetic doses. However, of the drugs in this class, only phenobarbital, mephobarbital, and metharbital are effective as oral anticonvulsants in subhypnotic doses.<\/p>\n

Barbiturates are respiratory depressants, and the degree of respiratory depression is dependent upon the dose. With hypnotic doses, respiratory depression produced by barbiturates is similar to that which occurs during physiologic sleep and is accompanied by a slight decrease in blood pressure and heart rate.<\/p>\n

Studies in laboratory animals have shown that barbiturates cause reductions in the tone and contractility of the uterus, ureters, and urinary bladder. However, concentrations of the drugs required to produce this effect in humans are not reached with sedative\/hypnotic doses.<\/p>\n

Barbiturates do not impair the normal hepatic function but have been shown to induce liver microsomal enzymes, thus increasing and\/or altering the metabolism of barbiturates and other drugs (see Drug Interactions under\u00a0PR\u00c9CAUTIONS<\/a>).<\/p>\n

\n

<\/a><\/a><\/p>\n

PHARMACOKINETICS<\/h3>\n

Barbiturates are absorbed in varying degrees following oral or parenteral administration. The salts are more rapidly absorbed than are the acids. The rate of absorption is increased if the sodium salt is ingested as a dilute solution or taken on an empty stomach.<\/p>\n

La dur\u00e9e d'action, qui est li\u00e9e \u00e0 la vitesse \u00e0 laquelle les barbituriques sont redistribu\u00e9s dans l'organisme, varie d'une personne \u00e0 l'autre et chez la m\u00eame personne de temps \u00e0 autre.<\/p>\n

Phenobarbital is classified as a long-acting barbiturate when taken orally. Its onset of action is 1 hour or longer, and its duration of action ranges from 10 to 12 hours.<\/p>\n

Barbiturates are weak acids that are absorbed and rapidly distributed to all tissues and fluids, with high concentrations in the brain, liver, and kidneys. Lipid solubility of the barbiturates is the dominant factor in their distribution within the body. The more lipid soluble the barbiturate, the more rapidly it penetrates all tissues of the body. Barbiturates are bound to plasma and tissue proteins to a varying degree with the degree of binding increasing directly as a function of lipid solubility.<\/p>\n

Phenobarbital has the lowest lipid solubility, lowest plasma binding, lowest brain protein binding, the longest delay in onset of activity, and the longest duration of action. The plasma half-life for phenobarbital in adults ranges between 53 and 118 hours with a mean of 79 hours. The plasma half-life for phenobarbital in children and newborns (less than 48 hours old) ranges between 60 to 180 hours with a mean of 110 hours.<\/p>\n

Barbiturates are metabolized primarily by the hepatic microsomal enzyme system, and the metabolic products are excreted in the urine, and, less commonly, in the feces. Approximately 25% to 50% of a dose of phenobarbital is eliminated unchanged in the urine. The excretion of unmetabolized barbiturate is one feature that distinguishes the long-acting category from those belonging to other categories, which are almost entirely metabolized. The inactive metabolites of the barbiturates are excreted as conjugates of glucuronic acid.<\/p>\n<\/div>\n<\/div>\n

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<\/a><\/a><\/p>\n

Indications and Usage for Nembutal Oral Solution<\/h2>\n

A. Sedative
\nB. Anticonvulsant – For the treatment of generalized and partial seizures.<\/p>\n<\/div>\n

\n

<\/a><\/a><\/p>\n

Contraindications<\/h2>\n

Phenobarbital is contraindicated in patients who are hypersensitive to barbiturates, in patients with a history of manifest or latent porphyria, and in patients with marked impairment of liver function or respiratory disease in which dyspnea or obstruction is evident.<\/p>\n<\/div>\n

<\/a><\/a><\/div>\n
\n

Warnings<\/h2>\n

1. Habit Forming<\/span><\/p>\n

Phenobarbital may be habit-forming. Tolerance and psychological and physical dependence may occur with continued use (see DRUG ABUSE AND\u00a0<\/a>DEPENDENCE\u00a0<\/a>et<\/span>\u00a0Pharmacokinetics under\u00a0LA PHARMACOLOGIE CLINIQUE<\/a>). Patients who have psychological dependence on barbiturates may increase the dosage or decrease the dosage interval without consulting a physician and may subsequently develop a physical dependence on barbiturates. In order to minimize the possibility of overdosage or the development of dependence, the prescribing and dispensing of sedative-hypnotic barbiturates should be limited to the amount required for the interval until the next appointment. Abrupt cessation after prolonged use in a person who is dependent on the drug may result in withdrawal symptoms, including delirium, convulsions, and possibly death. Barbiturates should be withdrawn gradually from any patient known to be taking excessive doses over long periods of time (see L'ABUS DE DROGUES ET LA D\u00c9PENDANCE<\/a>).<\/p>\n

2. Acute or Chronic Pain<\/span><\/p>\n

Caution should be exercised when barbiturates are administered to patients with acute or chronic pain because paradoxical excitement could be induced or important symptoms could be masked. However, the use of barbiturates as sedatives in the postoperative surgical period and as adjuncts to cancer chemotherapy is well established.<\/p>\n

3. Usage in Pregnancy<\/span><\/p>\n

Barbiturates can cause fetal damage when administered to a pregnant woman. Retrospective, case-controlled studies have suggested a connection between the maternal consumption of barbiturates and a higher-than-expected incidence of fetal abnormalities. Barbiturates readily cross the placental barrier and are distributed throughout fetal tissues; the highest concentrations are found in the placenta, fetal liver, and brain. Fetal blood levels approach maternal blood levels following parenteral administration.<\/p>\n

Withdrawal symptoms occur in infants born to women who receive barbiturates throughout the last trimester of pregnancy (see\u00a0L'ABUS DE DROGUES ET LA D\u00c9PENDANCE<\/a>).<\/p>\n

If Phenobarbital is used during pregnancy or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus.<\/p>\n

4. Usage in Children<\/span><\/p>\n

Phenobarbital has been reported to be associated with cognitive deficits in children taking it for complicated febrile seizures.<\/p>\n

5. Synergistic Effects<\/span><\/p>\n

Precaution<\/h2>\n
\n

Barbiturates may be habit-forming. Tolerance and psychological and physical dependence may occur with continued use (see L'ABUS DE DROGUES ET LA D\u00c9PENDANCE<\/a>).<\/p>\n

Barbiturates should be administered with caution, if at all, to patients who are mentally depressed, have suicidal tendencies, or have a history of drug abuse.<\/p>\n

Elderly or debilitated patients may react to barbiturates with marked excitement, depression, or confusion. In some persons, especially children, barbiturates repeatedly produce excitement rather than depression.<\/p>\n

Chez les patients pr\u00e9sentant une atteinte h\u00e9patique, les barbituriques doivent \u00eatre administr\u00e9s avec prudence et, dans un premier temps, \u00e0 des doses r\u00e9duites. Les barbituriques ne doivent pas \u00eatre administr\u00e9s aux patients pr\u00e9sentant des signes pr\u00e9monitoires de coma h\u00e9patique.<\/p>\n

The systemic effects of exogenous and endogenous corticosteroids may be diminished by Phenobarbital. Thus, this product should be administered with caution to patients with borderline hypoadrenal function, regardless of whether it is of pituitary or of primary adrenal origin.<\/p>\n<\/div>\n

\n

Information for Patients<\/h3>\n

The following information and instructions should be given to patients receiving barbiturates.<\/p>\n

1. The use of barbiturates carries with it an associated risk of psychological and\/or physical dependence. The patient should be warned against increasing the dose of the drug without consulting a physician.<\/p>\n

2. Barbiturates may impair the mental and\/or physical abilities required for the performance of potentially hazardous tasks, such as driving a car or operating machinery. The patients should be cautioned accordingly.<\/p>\n

3. Alcohol should not be consumed while taking barbiturates. The concurrent use of barbiturates with other CNS depressants (eg., alcohol, narcotics, tranquilizers, and antihistamines) may result in additional CNS-depressant effects.<\/p>\n<\/div>\n<\/div>\n<\/section>\n

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<\/a>R\u00e9f\u00e9rences<\/h2>\n
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