Barbiturates

Raquel M. Schears

Pharmacology

Treatment

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Barbiturates have been in common clinical use since 1903. These agents possess sedative properties used to reduce anxiety and hypnotic properties used to induce sleep—hence their classification as sedative-hypnotics. The therapeutic efficacy of these agents is best illustrated in their use as anticonvulsants in the treatment of seizure disorders, as induction agents in rapid-sequence intubation, and as antihypertensives in the management of increased intracranial pressure. 1

Barbiturates abuse, both prescription and illicit, peaked in the 1970s. The availability, as measured by sales and by the accidental death rate, was significantly correlated with their use for suicide.2 In the last two decades, the number of toxic exposures involving barbiturates and the incidence of overall barbiturate-related deaths have declined dramatically. This has been attributed to the advent and popularity of safer sedative-hypnotics such as the benzodiazepines and other major tranquilizers, rescheduling of barbiturates to class II, III, and IV drugs, and improvements in supportive care in overdose settings. 3 Nonetheless, illicit barbiturate use has again increased steadily in the United States since 1990, especially in adolescent populations. Reasons for this include youth perceptions that barbiturates are not very harmful and may be useful when taken in tandem with cocaine and methamphetamine to mitigate the unpleasant extremes of the stimulant effects.4,5 Also worrisome is the featured prominence of barbiturates used in recent mass suicide rituals and recommended in prescriptions for suicide published in the popular press and on the Internet.6 According to the 1997 Annual Report of the American Association of Poison Control Centers, barbiturates were involved in 5628 reported poisonings, with one-half of these captured as intentional overdoses that resulted in 54 deaths. 7 Clearly, barbiturates continue to rank among the most toxic classes of sedative-hypnotic agents that can pose life-threatening management problems for clinicians.

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