Barbiturates are sedatives that have limited use today since safer medications are available.Share on Pinterest

Barbiturates have been around for over 150 years. They were popular from the early 1900s through the 1970s. Two of the most common uses were for sleep and anxiety.

At one time there were over 50 types of barbiturates available in the United States. Ultimately, they were replaced by other medications because of safety concerns.

Read on to learn about the uses, effects, and risks of barbiturates.

  • Barbiturates are rarely used today. They have a high risk of tolerance, dependence, and overdose.
  • This class of medications can have short- to long-acting effects. It depends on the specific drug.
  • According to the National Institute on Drug Abuse (NIDA), in 2016 there were 409 deaths from overdose with barbiturates. Twenty-one percent included synthetic opioids.
  • You cannot suddenly stop taking barbiturates after regular use. It can trigger severe withdrawal symptoms. This includes the risk of death.

Barbiturates have a depressant effect on the brain. They increase gamma aminobutyric acid (GABA) activity in the brain. GABA is a brain chemical that creates a sedating effect.

The medications are habit forming. You can develop tolerance and dependence to barbiturates. This means you need higher amounts to get the same effect. Abruptly stopping this medication causes withdrawal symptoms.

Taking higher doses of barbiturates is dangerous because you can overdose. This is one of the reasons these medications are not prescribed as much now.

Today, these medications are used for:

  • anxiety and sedation related to surgery (if other drugs are not effective)
  • insomnia (rarely)
  • seizures (if other drugs haven’t worked)
  • anesthesia
  • tension headaches
  • traumatic brain injury (TBI)

Barbiturates are available in injectable, liquid, tablet, and capsule form. They come in many different strengths and combinations.

Barbiturates are a Drug Enforcement Administration (DEA) controlled substance because of their potential for misuse.

The DEA classifies drugs into five drug schedule categories, ranging from Schedule I to Schedule V. The schedule number indicates the likelihood the substance could be misused, as well as the drug’s accepted medical use.

For example, Schedule I drugs have no currently accepted medical use and a high potential for misuse. Schedule V drugs have a low potential for misuse.

Common names

Common names (generic and brand) for barbiturates include:

  • amobarbital injectable (Amytal), DEA Schedule II
  • butabarbital tablet (Butisol), DEA Schedule III
  • methohexital injectable (Brevital), DEA Schedule IV
  • pentobarbital injectable (Nembutal), DEA Schedule II
  • secobarbital capsules (Seconal), DEA Schedule II
  • primidone tablet (Mysoline). This medication is metabolized to phenobarbital. It’s used for seizure disorders and has no DEA Schedule.

Combination products used for headaches:

  • butalbital/acetaminophen capsule and tablet
  • butalbital/acetaminophen/caffeine capsule, tablet, and liquid solution, DEA Schedule III
  • butalbital/acetaminophen/caffeine/codeine tablet (Fioricet with codeine), DEA Schedule III
  • butalbital/aspirin/caffeine tablet and capsule (Fiorinal, Lanorinal), DEA Schedule III
  • butalbital/aspirin/caffeine/codeine capsule (Fiorinal with codeine), DEA Schedule III

The most common side effects of barbiturates are dizziness and drowsiness. Tasks that require you to be alert, like driving, might be challenging.

Some side effects are rare but very serious. These include:

  • difficulty breathing, chest pain, or tightness
  • rash
  • fever
  • joint pain
  • swelling of the face, lips, or throat
  • unusual bleeding or bruising

Call your healthcare provider right away if you experience any of these side effects.

Other possible side effects include:

  • headache
  • confusion
  • irritability
  • anxiousness
  • depression
  • disturbed sleep
  • low blood pressure
  • nausea
  • vomiting
  • problems with balance and movement
  • problems with speech, concentration, and memory

Talk with your healthcare provider to discuss any concerns about side effects.

Certain factors can increase the risk of side effects or overdose with barbiturate use. This includes your age, health conditions, and any other medications you’re taking.

Barbiturates can add to the sedating effects of other medications. This includes:

  • allergy medications such as antihistamines
  • pain medications, specifically opioids such as morphine and hydrocodone
  • sleep or anxiety medications (benzodiazepines)
  • alcohol
  • other medications that cause sedation or drowsiness

This drug class has limited use today because newer drugs have a much better safety record.

Barbiturates have a greater risk compared to the benefits. People prescribed these drugs must be carefully monitored to avoid side effects.

Pregnancy risk

There are risks linked to barbiturate use during pregnancy. These drugs are sometimes used if other medication options are unavailable.

Many older studies have established ties between barbiturate use during pregnancy with birth defects. Babies may have complications with growth and development if exposed to barbiturates long term during pregnancy.

Babies can also be born dependent on barbiturates and suffer from withdrawal symptoms after birth.

An animal study found exposure in newborn rats caused problems in brain development. The drug (pentobarbital) affected learning, memory, and other important functions.

Withdrawal symptoms

Barbiturates may cause death if suddenly stopped. Reaction severity depends on a person’s overall health, other health conditions they may have, and other medications being used.

If you have been taking a barbiturate, be sure to talk with your doctor before stopping the medication.

Some withdrawal symptoms of barbiturates include:

  • nausea and vomiting
  • stomach cramps
  • depression, anxiety, or restlessness
  • difficulty with sleep, concentration, and focus
  • heart problems
  • increased body temperature
  • seizures
  • tremors
  • delirium
  • hallucinations

For serious withdrawal symptoms, you may need to be monitored in the hospital until the drug is out of your body. This could take several days.

Barbiturates are available by prescription in three DEA schedule categories. This is based on their potential for addiction and misuse.

They’re still used legally in the hospital for anesthesia, sedation, TBI, seizures, and other select cases. They’re also prescribed for headaches and sleep if other medications have not worked.

However, barbiturates are still misused through illicit access. Illegal use has led to overdose deaths because the medications are dangerous for self-treatment. The danger increases when barbiturates are combined with alcohol, opioids, benzodiazepines like diazepam, or other drugs.

Barbiturates are still used in many countries because they’re less expensive. This is one reason they’re still available. They are also available through veterinary sources and laboratories for research purposes.

Online purchases are another illegal source of barbiturates. They come with greater risk because the drugs may be expired or contaminated with other substances.

It’s illegal to buy or use barbiturates without a doctor’s prescription. There are federal and state penalties for buying, selling, or taking the drugs illegally.

Barbiturates are not used very much today because of their poor safety record for overdoses. Many factors complicate why someone may be vulnerable to an overdose.

This includes:

  • other medications that have depressant effects on the brain, such as opioids and benzodiazepines
  • alcohol, which can slow the removal of the drug and cause a buildup in the body
  • history of depression, suicidal thoughts, or mental health conditions
  • history of substance use disorder
  • breathing problems, such as asthma, lung disease, and emphysema
  • heart problems
  • kidney or liver problems, which can cause the drug to build up in the body
  • age, which can affect vulnerability to side effects

There may be other reasons you react strongly to barbiturates. Be sure to discuss your medication and health history with your doctor.

Signs of an overdose

Call 911 or your local emergency number right away if you or someone you know has taken too much of a barbiturate or if you have any of these symptoms:

  • extreme drowsiness
  • trouble speaking
  • extreme weakness or tiredness
  • slow breathing
  • confusion
  • trouble with coordination and balance
  • very slow heart rate
  • turning blue
  • drop in body temperature

There is no reversal drug for the treatment of barbiturate overdose. Activated charcoal may be used to remove the excess drug from the body. Other measures include maintaining airway, circulation, and breathing.

Barbiturates have been replaced by benzodiazepines like alprazolam (Xanax) and diazepam (Valium) to treat anxiety and sleep disorder. They have fewer side effects when prescribed for home use compared to barbiturates.

Benzodiazepines work in a similar way by increasing GABA activity in the brain. They create a calming or relaxing effect. But if used together with barbiturates, they can increase overdose risk.

Benzodiazepines are also habit forming when used long term. They have similar side effects and risks for misuse. Benzodiazepines should only be used for a short period of time.

Barbiturates became popular from the early 1900s to the 1970s. There were few medication options to treat seizures, anxiety, and insomnia.

Doctors stopped using them when misuse and overdoses increased over time. Barbiturates have limited use today, and safer medications are available.

However, barbiturates are still being misused today. Risks for overdose deaths increase when they are used in combination with alcohol, opioids, benzodiazepines, or other medications.

Barbiturates need strict monitoring because of the risk of overdose and should never be used without doctor supervision.