BarbituratesWhat are the older sedatives, why did their use decline, and why are they still dangerous?

11What are barbiturates?

Barbiturates are medicines that slow the activity of the central nervous system. For decades they were the “sedatives” and “sleeping pills” in most pharmacies, before giving way to safer medicines.

Examples cited by the US National Institute on Drug Abuse (NIDA) include phenobarbital, secobarbital, methohexital and primidone. They belong to the family of sedatives and sleeping pills, but they are its oldest members and have the narrowest safety margin.

A scientific review published in 2021 explains that barbiturates were among the first sedatives to act on GABA receptors, and that their medical use has shrunk for most indications because of their dangerous effects and strong potential for misuse, although they are still used illicitly around the world.

12What is phenobarbital used for today?

According to MedlinePlus, phenobarbital is used to control epileptic seizures, sometimes to relieve anxiety, and to prevent withdrawal symptoms in people who are dependent on other barbiturates and want to stop. Some short-acting barbiturates are also used for anesthesia in hospitals. A medical review of sedative withdrawal syndromes notes that phenobarbital is one of the medicines doctors use under monitoring to control alcohol and sedative withdrawal.

13How do barbiturates work in the brain?

As the MSD Manual explains, barbiturates bind to type A GABA receptors, the same receptors that benzodiazepines act on, and strengthen their calming effect. A StatPearls review explains that they prolong the time the receptor channel stays open and, at the same time, weaken the brain’s response to the stimulating transmitter glutamate. The result is calming, drowsiness and prevention of seizures, but as the amount rises, the depression extends to the breathing centers in the brainstem, so breathing weakens and may stop.

14Forms and names of barbiturates

Barbiturates come as tablets, capsules and syrup, and some are injections used in hospitals. NIDA lists some of their US brand names: Seconal for secobarbital, Brevital for methohexital, and Mysoline for primidone. In Egypt, Sominaleta is one of the best-known brand names for phenobarbital, and it is also available under its generic name. Common street names worldwide include “barbs” and “reds.”

15Why are barbiturates misused?

MedlinePlus explains that most people who take these medicines for epilepsy or pain syndromes do not misuse them, and that those who do often start with a medicine prescribed to them or to a family member. Common patterns include:

• Increasing the amount without consulting the doctor, seeking deeper sleep or calm.
• Using a family member’s medicine without a prescription.
• Deliberately mixing them with alcohol or opioids to alter consciousness, which MedlinePlus warns against because it can lead to coma or death.
• Using them to soften the effect of other substances, or their withdrawal, without supervision.

16The difference between barbiturates and benzodiazepines

The 2021 review sums up the idea: benzodiazepines replaced barbiturates for most indications because they are less likely to cause serious effects when used alone. But this does not mean benzodiazepines are always safe; they also carry risks of addiction and withdrawal, as with Valium and Roche pills.

17The legal status of barbiturates

In Egypt, barbiturates are prescription-only medicines, and trading in them or using them outside a medical setting is an offense. In the United States, for example, they fall under different controlled schedules depending on the type, according to NIDA. For anyone struggling with misuse of them, the Fund for Drug Control and Treatment of Addiction offers free, confidential treatment through hotline 16023.

This is general educational information and not legal advice.

18Barbiturates Guide: Everything You Need to Know

We have gathered everything about barbiturates into 2 pages, each answering one question in detail. Choose what you are looking for:

19Epilepsy medicine from the barbiturate group at home? Tips for families

1. Keep the medicine locked away, out of reach of children and other family members, because much misuse begins with a relative’s medicine.
2. Do not give it to anyone else, even if their symptoms are “similar.”
3. Keep to the appointments for tests and follow-ups that the doctor requests, and do not change the dose without consulting them.
4. Avoid alcohol completely while using it, and tell any doctor or dentist that you take it.
5. If you notice unusual drowsiness, unsteadiness or slurred speech in someone who takes it, take them to the doctor.
6. Learn the danger signs listed at the bottom of the page, and save the ambulance number, 123.

20Harms, symptoms, withdrawal and treatment in brief

Harms: The most serious is an overdose that depresses breathing, especially with alcohol or opioids, along with chronic effects on memory and concentration. Details are in harms of barbiturates.

Symptoms: They resemble intoxication: drowsiness, slow slurred speech, unsteadiness, difficulty thinking and poor judgment, and with long-term use, irritability and impaired memory, according to MedlinePlus.

Withdrawal: It can be life-threatening and includes tremor, agitation, seizures and delirium, which is why it is done only gradually and under supervision. Details are in barbiturate withdrawal symptoms.

Treatment: According to NIDA there are no medications approved specifically for sedative addiction, but treatment is effective: medical detox with slow reduction and monitoring for seizures, then cognitive behavioral and motivational therapy, within an addiction treatment plan suited to each case.