Risk of drug dependence and abuse posed by barbiturate-containing analgesics.

Sellers EM, Hoornweg K, Busto UE, Romach MK.

Department of Pharmacology, Faculty of Pharmacy, University of Toronto, Ontario. e.sellers utoronto.ca

Concern has been raised that the barbiturate component of barbiturate-containing analgesics constitutes a public and individual health problem because of information from literature before 1966 concerning preclinical and clinical abuse liability, and the dependence risk of barbiturates. The safety of barbiturates alone and in combination in analgesics was reviewed. In addition, information from manufacturers of combination products were evaluated. A meta-analysis was not possible because of the paucity of formal clinical trials. Even though barbiturates have a narrow margin of safety and substantial abuse potential, there is no evidence that barbiturate-containing analgesics without codeine represent a public health or social problem because of their abuse potential. However, proper studies to confirm this theory have not been performed. In the absence of better data concerning efficacy and lack of dependence potential, barbiturate-containing analgesics are not first-line medications for the initiation of treatment for pain. Codeine-containing combination analgesics have the potential to be a more important public health problem than those with only barbiturate in the combination.

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Complications and costs of treatment of refractory generalized convulsive status epilepticus in children.

Gilbert DL, Glauser TA.

Department of Neurology, Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. gilbd0 chmcc.org

Multiple case series in the literature suggest that benzodiazepines and barbiturates are highly efficacious at stopping seizures. Apparent differences in mortality might not be due solely to drug effect. In this systematic review of the medical literature, we assessed the complications and costs of treatment of refractory status epilepticus in 111 children who met strict inclusion criteria, as part of an effort to provide an evidenced-based recommendation for optimal therapy. All children treated with barbiturates required mechanical ventilation, versus 13% of patients treated with benzodiazepines. Benzodiazepine treatment was associated with pressor use in 3.5% of cases, versus 35% with barbiturate treatment. Midazolam treatment was for the shortest duration and allowed the most rapid return to consciousness. Differences in mean 24-hour drug costs were small compared to savings produced by shorter length of treatment and return to consciousness. Benzodiazepines appear to have higher drug costs but lower complications and overall costs than barbiturates.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10488905&dopt=Abstract barbiturate Butalbital Fioricet





Barbiturate anesthesia and brain proton spectroscopy.

Lundbom NM, Manner T, Komu M, Peltola O, Leino KA, Kirvela OA.

Department of Radiology, Turku University Hospital, Finland.

BACKGROUND AND PURPOSE: Thiopentone reduces CBF and metabolic rate. Still, it is widely used for sedation during MR spectroscopy. We investigated whether barbiturate anesthesia and preanesthetic fasting have an effect on metabolic ratios in proton MR spectroscopy of the brain. METHODS: Eight healthy, consenting, male volunteers were studied twice in a random, crossover fashion. The study sessions were conducted during fasting (F) and nonfasting (nonF), with glucose infusion mimicking the fed state. During both sessions, two sets of spectroscopic data were collected, one during the awake state (F or nonF) and one under barbiturate anesthesia (F+B or nonF+B), using TEs of 135 and 270. Spectral areas of N-acetylaspartate (NAA), choline-containing compounds (Cho), and creatine plus phosphocreatine (Cr) were calculated, and the presence of lactate or lipid was noted. Venous blood samples for glucose, beta-hydroxybutyrate, lactate, and electrolytes were collected. RESULTS: Barbiturate anesthesia caused a 42% reduction in blood lactate levels during fasting, but not during glucose infusion. There were no differences in NAA/Cho, NAA/Cr, or in Cho/Cr between the groups F, nonF, F+B, or nonF+B. No lactate or lipid resonances were detected. CONCLUSION: Barbiturate anesthesia with preanesthetic fasting can be used for proton spectroscopy at TEs of 135 or 270 without interference from NAA/Cho, NAA/Cr, or Cho/Cr or from the appearance of lactate or lipid.

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Comparison of the serum barbiturate fluorescence polarization immunoassay by the COBAS INTEGRA to a GC/MS method.

Cannon RD, Wong SH, Gock SB, Jentzen JJ.

Office of the Milwaukee County Medical Examiner and the Department of Pathology, Medical College of Wisconsin, 53233, USA.

The authors evaluated a new Cassette Serum Barbiturates fluorescence polarization immunoassay (FPIA) on the COBAS INTEGRA. The assay was calibrated with secobarbital standards at 0, 0.5, and 4.0 microg/mL. The assay range was 0.030 to 80 microg/mL using an automatic 1/20 postdilution feature. Precision was established for two COBAS INTEGRA instruments for ten days by assaying secobarbital target concentrations ranging from 0.125 to 2.2 microg/mL. The coefficients of variation (CV) for the above target concentrations for the first instrument ranged from 2.7% to 8.3%, and for a second instrument, 3.8 to 8.3%. Seven clinically elevated bilirubin samples were spiked with 0.46 and 1.77 microg/mL secobarbital. Bilirubin interference was less than 10.9 and less than 7.9%, respectively. The average recovery ranged from 85% to 94%. The mean difference in recovery in serum versus plasma was < or = 3%. Fifty-two clinical samples were analyzed for butalbital, pentobarbital, secobarbital, and phenobarbital by GC/MS, and the results were compared to the new Cassette Serum Barbiturates FPIA. The diagnostic sensitivity and specificity were 95% and 100%, respectively. Both FPIA and GC/MS assays are clinically efficacious for monitoring serum barbiturates.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10519455&dopt=Abstract barbiturate Butalbital Fioricet