Methohexital
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chetan Lokhande, M.B.B.S [2]
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Black Box Warning
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WARNING
See full prescribing information for complete Boxed Warning.
Brevital should be used only in hospital or ambulatory care settings that provide for continuous monitoring of respiratory (e.g. pulse oximetry) and cardiac function. Immediate availability of resuscitative drugs and age- and size-appropriate equipment for bag/valve/mask ventilation and intubation and personnel trained in their use and skilled in airway management should be assured. For deeply sedated patients, a designated individual other than the practitioner performing the procedure should be present to continuously monitor the patient. (See WARNINGS)
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Overview
Methohexital is a general anesthetic that is FDA approved for the {{{indicationType}}} of anesthesia. There is a Black Box Warning for this drug as shown here. Common adverse reactions include cardiovascular: hypotension, dermatologic: injection site pain, musculoskeletal: spasmodic movement, respiratory: cough, hiccoughs, laryngeal spasm.
Adult Indications and Dosage
FDA-Labeled Indications and Dosage (Adult)
- Anesthesia: induction, 1 to 1.5 mg/kg (50 to 120 mg, mean 70 mg) IV administered at a rate of 1 mL every 5 seconds (1% solution), which usually provides anesthesia for 5 to 7 minutes; gaseous anesthetics and skeletal muscle relaxants may be administered concomitantly [2]
- Anesthesia: maintenance, intermittent IV injections of 20 to 40 mg (2 to 4 mL of a 1% solution) as required, usually every 4 to 7 minutes OR by continuous IV drip of 3 mL/min (0.2% solution); individualize flow rate for each patient; for longer surgical procedures, gradual reduction in the administration rate is recommended [2]
- Procedural sedation: 0.75 to 1 mg/kg IV; can be re-dosed 0.5 mg/kg every 2-5 min as needed
Off-Label Use and Dosage (Adult)
Guideline-Supported Use
- Procedural sedation.
Non–Guideline-Supported Use
There is limited information about Off-Label Non–Guideline-Supported Use of Methohexital in adult patients.
Pediatric Indications and Dosage
FDA-Labeled Indications and Dosage (Pediatric)
- Anesthesia: (older than 1 month) 6.6 to 10 mg/kg IM (5% solution) OR 25 mg/kg RECTALLY (1% solution).
- Procedural sedation: 25 mg/kg RECTALLY as 1% solution.
- Procedural sedation: 0.5 to 1 mg/kg IV.
Off-Label Use and Dosage (Pediatric)
Guideline-Supported Use
- Procedural sedation
Non–Guideline-Supported Use
There is limited information about Off-Label Non–Guideline-Supported Use of Methohexital in pediatric patients.
Contraindications
- Brevital Sodium is contraindicated in patients in whom general anesthesia is contraindicated, in those with latent or manifest porphyria, or in patients with a known hypersensitivity to barbiturates.
Warnings
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WARNING
See full prescribing information for complete Boxed Warning.
Brevital should be used only in hospital or ambulatory care settings that provide for continuous monitoring of respiratory (e.g. pulse oximetry) and cardiac function. Immediate availability of resuscitative drugs and age- and size-appropriate equipment for bag/valve/mask ventilation and intubation and personnel trained in their use and skilled in airway management should be assured. For deeply sedated patients, a designated individual other than the practitioner performing the procedure should be present to continuously monitor the patient. (See WARNINGS)
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See boxed Warning.
As with all potent anesthetic agents and adjuncts, Brevital should be used only in hospital or ambulatory care settings that provide for continuous monitoring of respiratory (e.g. pulse oximetry) and cardiac function. Immediate availability of resuscitative drugs and age- and size-appropriate equipment for bag/valve/mask ventilation and intubation and personnel trained in their use and skilled in airway management should be assured. For deeply sedated patients, a designated individual other than the practitioner performing the procedure should be present to continuously monitor the patient.
Maintenance of a patent airway and adequacy of ventilation must be ensured during induction and maintenance of anesthesia with methohexital sodium solution. Laryngospasm is common during induction with all barbiturates and may be due to a combination of secretions and accentuated reflexes following induction or may result from painful stimuli during light anesthesia. Apnea/hypoventilation may be noted during induction, which may impair pulmonary ventilation; the duration of apnea may be longer than that produced by other barbiturate anesthetics. Cardiorespiratory arrest may occur.
This prescribing information describes intravenous use of methohexital sodium in adults. It also discusses intramuscular and rectal administration in pediatric patients older than one month. Although the published literature discusses intravenous administration in pediatric patients, the safety and effectiveness of intravenous administration of methohexital sodium in pediatric patients have not been established in well-controlled, prospective studies. (See PRECAUTIONS— Pediatric Use)
Seizures may be elicited in subjects with a previous history of convulsive activity, especially partial seizure disorders.
Because the liver is involved in demethylation and oxidation of methohexital and because barbiturates may enhance preexisting circulatory depression, severe hepatic dysfunction, severe cardiovascular instability, or a shock-like condition may be reason for selecting another induction agent.
Prolonged administration may result in cumulative effects, including extended somnolence, protracted unconsciousness, and respiratory and cardiovascular depression. Respiratory depression in the presence of an impaired airway may lead to hypoxia, cardiac arrest, and death.
The CNS-depressant effect of Brevital Sodium may be additive with that of other CNS depressants, including ethyl alcohol and propylene glycol.
Adverse Reactions
Clinical Trials Experience
Side effects associated with Brevital Sodium are extensions of pharmacologic effects and include:
Cardiovascular—Circulatory depression, thrombophlebitis, hypotension, tachycardia, peripheral vascular collapse, and convulsions in association with cardiorespiratory arrest
Respiratory—Respiratory depression (including apnea), cardiorespiratory arrest, laryngospasm, bronchospasm, hiccups, and dyspnea
Neurologic—Skeletal muscle hyperactivity (twitching), injury to nerves adjacent to injection site, and seizures
Psychiatric—Emergence delirium, restlessness, and anxiety may occur, especially in the presence of postoperative pain
Gastrointestinal—Nausea, emesis, abdominal pain, and liver function tests abnormal
Allergic—Erythema, pruritus, urticaria, and cases of anaphylaxis have been reported rarely
Other—Other adverse reactions include pain at injection site, salivation, headache, and rhinitis
For medical advice about adverse reactions contact your medical professional. To report SUSPECTED ADVERSE REACTIONS, contact JHP at 1-866-923-2547 or MEDWATCH at 1-800-FDA-1088 (1-800-332-1088) or http://www.fda.gov/medwatch/.
Postmarketing Experience
There is limited information regarding Methohexital Postmarketing Experience in the drug label.
Drug Interactions
There is limited information regarding Methohexital Drug Interactions in the drug label.
Use in Specific Populations
Pregnancy
Pregnancy Category (FDA): B
Reproduction studies have been performed in rabbits and rats at doses up to 4 and 7 times the human dose respectively and have revealed no evidence of harm to the fetus due to methohexital sodium. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed
Pregnancy Category (AUS):
There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Methohexital in women who are pregnant.
Labor and Delivery
Brevital Sodium has been used in cesarean section delivery but, because of its solubility and lack of protein binding, it readily and rapidly traverses the placenta.
Nursing Mothers
Caution should be exercised when Brevital Sodium is administered to a nursing woman.
Pediatric Use
The safety and effectiveness of methohexital sodium in pediatric patients below the age of 1 month have not been established. Seizures may be elicited in subjects with a previous history of convulsive activity, especially partial seizure disorders. Apnea has been reported following dosing with methohexital regardless of the route of administration used. Studies using methohexital sodium intravenously in pediatric patients have been reported in the published literature. This literature is not adequate to establish the safety and effectiveness of intravenous administration of methohexital sodium in pediatric patients. Due to a variety of limitations such as study design, biopharmaceutic issues, and the wide range of effects observed with similar doses of intravenous methohexital, additional studies of intravenous methohexital in pediatric patients are necessary before this route can be recommended in pediatric patients. (See WARNINGS)
Geriatic Use
Clinical studies of Brevital did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. Elderly subjects may commonly have conditions in which methohexital should be used cautiously such as obstructive pulmonary disease, severe hypertension or hypotension, preexisting circulatory depression, myocardial disease, congestive heart failure, or severe anemia. Caution should be exercised in debilitated patients or in those with impaired function of respiratory, circulatory, renal, hepatic, or endocrine systems (see WARNINGS, PRECAUTIONS and ADVERSE REACTIONS). Barbiturates may influence the metabolism of other concomitantly used drugs that are commonly taken by the elderly, such as anticoagulants and corticosteroids. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy (see PRECAUTIONS-Drug Interactions).
Gender
There is no FDA guidance on the use of Methohexital with respect to specific gender populations.
Race
There is no FDA guidance on the use of Methohexital with respect to specific racial populations.
Renal Impairment
There is no FDA guidance on the use of Methohexital in patients with renal impairment.
Hepatic Impairment
There is no FDA guidance on the use of Methohexital in patients with hepatic impairment.
Females of Reproductive Potential and Males
There is no FDA guidance on the use of Methohexital in women of reproductive potentials and males.
Immunocompromised Patients
There is no FDA guidance one the use of Methohexital in patients who are immunocompromised.
Administration and Monitoring
Administration
There is limited information regarding Methohexital Administration in the drug label.
Monitoring
There is limited information regarding Methohexital Monitoring in the drug label.
IV Compatibility
There is limited information regarding the compatibility of Methohexital and IV administrations.
Overdosage
There is limited information regarding Methohexital overdosage. If you suspect drug poisoning or overdose, please contact the National Poison Help hotline (1-800-222-1222) immediately.
Pharmacology
There is limited information regarding Methohexital Pharmacology in the drug label.
Mechanism of Action
There is limited information regarding Methohexital Mechanism of Action in the drug label.
Structure
There is limited information regarding Methohexital Structure in the drug label.
Pharmacodynamics
There is limited information regarding Methohexital Pharmacodynamics in the drug label.
Pharmacokinetics
There is limited information regarding Methohexital Pharmacokinetics in the drug label.
Nonclinical Toxicology
There is limited information regarding Methohexital Nonclinical Toxicology in the drug label.
Clinical Studies
There is limited information regarding Methohexital Clinical Studies in the drug label.
How Supplied
There is limited information regarding Methohexital How Supplied in the drug label.
Storage
There is limited information regarding Methohexital Storage in the drug label.
Images
Drug Images
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Package and Label Display Panel
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Patient Counseling Information
There is limited information regarding Methohexital Patient Counseling Information in the drug label.
Precautions with Alcohol
Alcohol-Methohexital interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
Brand Names
There is limited information regarding Methohexital Brand Names in the drug label.
Look-Alike Drug Names
There is limited information regarding Methohexital Look-Alike Drug Names in the drug label.
Drug Shortage Status
Price
References
The contents of this FDA label are provided by the National Library of Medicine.