Stability of Pentobarbital in Water and Oral Pediatric Suspensions

Abstract

To ensure motionless conditions during computed tomography or magnetic resonance imaging in infants, sedative drugs could be used but with the potential risk of adverse effects such as respiratory depression. 1 Pentobarbital sodium (Nembutal) and chloral hydrate are the more frequently used drugs. 2 Clinical studies reported the effectiveness of pentobarbital sedation and a decreased rate of adverse events as compared with chloral hydrate for imaging sedative procedures. 3 Pentobarbital is usually administered to infants at the dose of 4 to 5 mg/kg, with a maximum of 8 mg/kg. 3 Nembutal is not available in the United States and Europe, and some hospital pharmacy units prepare rectal or oral forms. To facilitate its administration, we chose to study pentobarbital sodium stability in water and compounded in 5 suspensions. Methods Pentobarbital sodium powder (Inresa, Bartenheim, France) was used to prepare 6 different suspensions at 25 mg/mL in deionized water (Fresenius,

Stability of Pentobarbital Hydrogel for Rectal Administration in Pediatric Procedural Sedation

“…14,15 The oral suspensions were prepared using pharmaceutical grade powder with a beyond use date of 60 days in InOrpha ® when stored under refrigeration. 12 However, the poor palatability of this oral suspension is a serious obstacle to the acceptance for oral administration to children resulting in failure of examination by refusal or vomiting. 8,9 Rectal administration offers some advantages in children including the risks of nausea and vomiting, the presence of diseases of the upper gastrointestinal tract, the bitter taste, the achievement of rapid effect, and the rate of drug not influenced by food.…”

“…7,9,11 As the human injectable form of pentobarbital is marketed only in the United States and the veterinary injectable form of drug is available in France, extemporaneous oral liquid forms of pentobarbital are prepared by European hospital pharmacists. 11,12 Oral rectal pentobarbital has high bioavailability (>95%) with onset of sedation ranging from 20 to 30 minutes and a duration of sedation ranging from 60 to 90 minutes. 4 The time from administration to discharge is longer than with intravenous (IV) pentobarbital, but adverse events are uncommon, <1% for both respiratory and behavioral issues.…”