Barbiturates: Definition, Uses, Side Effects, and More
Wellness & SelfcareDrugs

Barbiturates

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Updated on October 30, 2024
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Barbiturates are a category of medication that causes relaxation and sleepiness. In the past, they were regularly prescribed to treat insomnia, alcohol withdrawal, seizures, and a range of mental health disorders. But because barbiturates are highly addictive, benzodiazepines are now more commonly prescribed instead.

What Are Barbiturates?

Barbiturates are sedative-hypnotic drugs, meaning they help you relax or fall asleep. They work by depressing the central nervous system. They increase a brain chemical called gamma-aminobutyric acid (GABA) that slows down brain cell activity.

Barbiturates were very popular in the mid-to-late 20th century. They were typically prescribed to treat conditions such as insomnia, epilepsy, for anesthesia reasons, and for certain psychiatric disorders.

Barbiturates are also highly addictive. By the 1970s, people had widely misused them, leading to accidental overdoses, addiction, and death. As a result, barbiturates were mostly replaced with safer drugs such as benzodiazepines, which also slow down brain activity.

Barbiturates are still prescribed today, but they aren’t widely used in the United States. They’re often used as a second choice for seizures when other medications aren’t improving symptoms.

What Conditions Do Barbiturates Treat?

Historically, barbiturates were prescribed for:

Since the 1970s, barbiturates have been largely replaced by benzodiazepines — depressant or sedative drugs that treat many of the same conditions and have a better safety profile.

Barbiturates are still used today when other medications aren’t effectively treating a health condition. Those issues include:

  • Seizures
  • Tension headaches
  • As anesthesia prior to surgery

Types of Barbiturates

Barbiturates are usually taken orally, as tablets. But, they also can be injected into the muscle or vein.

Barbiturates are often classified according to how long their effects last. The four main types of barbiturates are:

Ultra-Short Acting Barbiturates

These barbiturates’ effects last 15 minutes or less.

Examples include methohexital (Brevital Sodium) and thiopental (Pentothal), which is no longer available in the United States.

Methohexital is useful for short-duration sedation in some cardiovascular surgeries and other short emergency procedures. It’s also helpful for electroconvulsive therapy and for short outpatient surgeries in children.

Short-Acting Barbiturates

The effects of short-acting barbiturates typically last around three or four hours. Examples include pentobarbital (Nembutal Sodium) and secobarbital (Seconal), which is no longer available in the United States. Pentobarbital is used before anesthesia or to stop seizures. It’s also prescribed off-label to help relieve pressure inside the skull after a traumatic brain injury (TBI).

Intermediate-Acting Barbiturates

Intermediate-acting barbiturates have effects that last about three to six hours. This category of drugs includes amobarbital (Amytal) and butalbital (Fiorinal). The brand names Amytal and Fiorinal have been discontinued in the United States.

Butalbital is sometimes used as part of combination medications — together with aspirin, acetaminophen, or caffeine — to treat migraines and tension headaches. The American Academy of Neurology (AAN) doesn’t recommend taking it for long periods of time because of how highly addictive it is and because it can lead to medication overuse headaches.

Long-Acting Barbiturates

The effects of long-acting barbiturates usually last for 6 to 12 hours. Examples include phenobarbital and primidone (Mysoline). Phenobarbital is a drug typically used for treating epilepsy in both adults and children. Primidone is used to treat seizure disorders.

How Do Barbiturates Work?

Barbiturates boost a chemical in the brain (a neurotransmitter) called gamma-aminobutryic acid (GABA). GABA blocks the activity of certain nerve cells, so by boosting it, barbiturates depress the central nervous system in a similar way to alcohol.

Historically, the depressive effects of barbiturates have been helpful for treating insomnia or anxiety, as they can make you feel sleepy and relaxed.

But when taken in higher doses, or more than recommended, barbiturates can cause serious effects.

What Are the Possible Side Effects of Barbiturates?

Most people who use barbiturates for seizure or pain don’t abuse them. But barbiturate use can lead to addiction problems for some people who take it. Some of their most common side effects include:

  • Drowsiness, dizziness, or confusion
  • Headache
  • Nausea or vomiting

Are There Any Risks Related to Barbiturates?

Misusing barbiturates or taking more than the recommended dose can have dangerous effects on a person’s health, including:

  • Confusion and difficulty thinking
  • Sleepiness
  • Faulty judgment
  • Lack of coordination
  • Shallow, slowed, or difficulty breathing
  • Slow or slurred speech
  • Balance issues
  • Swelling of the eyes, lips, or cheeks
  • Rash, blistering, or peeling skin
  • Fever

If you suspect an overdose in yourself or in someone else, or if someone is having trouble breathing, call 911 or go to an emergency room immediately. You can also call your local poison control center at 800-222-1222 from anywhere in the United States.

Barbiturates pose other serious risks, including:

  • High Potential for Dependence If a person takes barbiturates for longer than two weeks, they may become physically and psychologically addicted to them. Barbiturates also lose effectiveness after a few weeks, so a higher dose may be required to achieve the same effects. This increases the risks for abuse even further.
  • Withdrawal Symptoms These can occur from long-term use. If you are not tapered off the medication, you may experience hallucinations (seeing or hearing things that aren’t there), fever, and seizures. Some withdrawal symptoms can be life-threatening.
  • Risk of Harming the Fetus if Taken During Pregnancy Barbiturates are not suitable for pregnant people as they can harm the fetus, causing birth defects in newborns.
  • Interactions With Other Drugs Barbiturates interact with many drugs, including steroids, blood thinners, immunosuppressants, and contraceptives. They can also have dangerous effects if combined with other drugs that have the same effect on the central nervous system, like opioids or benzodiazepines.

The Takeaway

  • Barbiturates are powerful sedative medications that have largely fallen out of favor because they’re highly addictive.
  • These medications were historically used for sleep issues, anxiety, and seizures, but today they are only prescribed in limited situations when other drugs haven’t helped.
  • They can cause withdrawal symptoms when a person stops taking them, and they may have dangerous effects if combined with other sedative medications.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. What Are Barbiturates? Cleveland Clinic. June 14, 2022.
  2. Suddock JT et al. Barbiturate Toxicity. StatPearls. February 2024.
  3. Skibiski J et al. Barbiturates. StatPearls. January 2024.
  4. Amobarbital Sodium Injection. American Society of Health-System Pharmacists. September 2024.
  5. Barbiturates. MedlinePlus. July 2023.
  6. Phenobarbital. MedlinePlus. May 2020.
Meet Our Experts
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Kristina D. Carter, PharmD

Medical Reviewer

Kristina D. Carter, PharmD, is a clinical pharmacist and freelance health writer who currently works in a managed care setting, performing quality audits on utilization management case reviews for the pharmacy team. She has over 20 years of experience and has worked in several pharmacy practice settings, including at a community pharmacy as well as in ambulatory care, senior care, and pharmacy operations.

She received her doctor of pharmacy degree from Xavier University of Louisiana College of Pharmacy and her master's of business administration and health administration from Georgia State University Robinson College of Business. She is an American Council on Exercise–certified health coach, group fitness instructor, senior fitness specialist, and weight management specialist. She is also a registered pharmacist, licensed in Georgia, Indiana, and Tennessee.

Dr. Carter enjoys exploring new restaurants with family and friends, walking along city trails, and watching action movies and college sports.

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Outside of work, she loves dancing, taking analog photos, and binge-watching all the RuPaul’s Drag Race franchises.

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EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. What Are Barbiturates? Cleveland Clinic. June 14, 2022.
  2. Suddock JT et al. Barbiturate Toxicity. StatPearls. February 2024.
  3. Skibiski J et al. Barbiturates. StatPearls. January 2024.
  4. Amobarbital Sodium Injection. American Society of Health-System Pharmacists. September 2024.
  5. Barbiturates. MedlinePlus. July 2023.
  6. Phenobarbital. MedlinePlus. May 2020.
Additional Sources