THIOPENTAL

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Created Feb 2021

THIOPENTAL

  • [SODIUM THIOPENTAL]
  • [PENTOTHAL]
  • [SODIUM PENTOTHAL]
  • [THIOPENTONE]
  • [TRAPANAL]

DEA CODE 2100: Schedule 3

Pentothal

Pentothal

Pentothal is the brand name drug that is used to induce general anesthesia in patients prior to surgery. The generic form of the drug is thiopental. The medication is only given intravenously. Once it is given, the drug reaches the brain and the patient falls asleep in about 30 to 45 seconds. Pentothal is an ultra-short acting barbiturate and is only administered in a hospital setting under the care of qualified physicians and anesthesiologists. It is not prescribed to patients for personal use. Pentothal is also used in veterinary medicine to induce general anesthesia. In addition to being used to induce general anesthesia in humans and animals, Pentothal can be used for other purposes in various parts of the world. Other uses include lethal injection, euthanasia, truth serum, psychiatry, stopping a seizure and to induce a coma.

How Long Does it Stay in Your System?
It is given intravenously and can stay in your system for up to 6 days, depending on a variety of factors. Inform your doctor if you are experiencing any side effects from Pentothal and avoid any interacting medications and alcohol while the drug remains in your system. If you're unsure about the safety of taking other medications or drinking alcohol after receiving an injection of Pentothal, talk to your doctor.

The drug Sodium Thiopental, marketed as "Penthotal", was discovered in the early 1930s by Abbott Laboratories. It was originally intended to be a new pain killing medicine but showed no results in initial testing. The first human tests on the properties of the new drug commenced in 1934 under Dr Ralph Waters. He found that it had some short-term anaesthetic properties, but again provided no pain relief. Soon afterwards, his colleague Dr John Lundy, started clinical trials on the request of Abbott and the drug was then manufactured until 2004.

When Sodium Thiopental is mentioned, there are usually two things, with which it is associated. The first is that it caused larger numbers of fatalities at Pearl Harbor than the Japanese surprise attack itself, and the other, for avid lovers of spy and crime fiction, is its use as a truth serum.

Truth Serum:
Initially used by doctors during childbirth, it quickly became apparent, that the women continued to discourse freely, while under the influence. They also responded to questions put to them. Clinicians noted uninhibited reactions to questions, free from outside considerations and influences, and it was logically assumed that they spoke the truth. News about this particular effect of this drug reached psychoanalysts, who were looking for a way to help the severely shell-shocked combatants from the two World Wars. Many of the combatants had great difficulty speaking, if they were able to do so at all. Earlier barbiturates had been used in the same way to reduce anxieties and enable the soldiers to speak about their experiences and, ultimately, heal them.

This knowledge then passed on to the police, who quickly saw the potential use of the truth serum in questioning suspects and prisoners. As with the women during childbirth, the prisoners of their situation was supposed to be nullified, so that they would answer questions without making up their own responses. Writers of spy and detective fiction also incorporated this new technique into their work and spread the word to the general public. It sounded logical that a person who was unaware of their surroundings would obviously tell nothing but the truth. And many convictions were made using this method in the US in the early years. Other people looking for the truth, psychiatrists, were soon including truth serums into their practice as well. For them, the potential of unlocking the truth of a patient's past was the aim and patients were 'led back in time' to confront traumas of the past.

A changing point came in 1973 with the publication of the 'Sybil' case, she had been a psychiatric patient since the 1950s onwards, whose diagnosis had established multiple personalities syndrome. Sybil (her real name was Shirley Mason), had been injected with Thiopental after she had presented multiple personalities in her therapy sessions. Reviewing the case later from recordings and transcripts kept by her therapist, it became evident that the psychoanalyst had led her to create 'false memories' and she had obliged and confessed that she had made up all of the other personalities and events. She also had exhibited clear addiction symptoms to Thiopental, but the therapy injections had continued nonetheless. With the publication of the book "Sybil", named after one of the personalities she presented, Mason was eventually 'cured' in 1965. She went into hiding and avoided all friends and family before she died in the late 1980s.

Sybil

Pearl Harbor:
Apart from the use as a truth serum, the most repeated 'fact' about the drug sodium thiopental is the high number of fatalities it caused in the Hawaiian port of Pearl Harbor after the Japanese surprise attack on 7 December 1941. On that day, there had been 2403 casualties and 1178 wounded amongst US servicemen during and after the attack. 1227 men alone had died on the USS Arizona. Due to lack of details about medical treatment being made available by the US Government, these numbers in themselves were the main point of discussion through the decades, and the relatively new drug Pentothal was presented as the ultimate reason for the large numbers of fatalities alone. It had only been demonstrated to the Army and Navy medical personnel in the days shortly before the attack, and from that point the warning to medical students from the 1950s all the way to the 1990s was:

[...] if you go on to do anaesthesia, you must use this thiopental with great care and diligence because the Yanks killed more of their own at Pearl Harbor than did the Japanese in their attack [...]
Only with the release of documents in 1995 under the Freedom of Information Act was it possible to look at the pure facts and first-hand accounts. A surgeon at one of the army hospitals, which had admitted 160 wounded within 2-3 hours of the start of the attacks, recounted many years later:
Anaesthesia was a problem. Some of the debridements were done under local anaesthesia. But general anaesthesia was needed in many cases and the only nurse anaesthetist was busy in the operating room. [...] We had just been issued a new drug called Pentothal which could be given IV [intravenously] for anaesthesia. We got a box, read the directions and [...] used it on many cases over the next 48 hours with excellent results.
With this as with other reports, there is no mention of any excess in mortality or death related to the use of the drug. Civilian hospitals, which did not come under the restrictions of issuing statements but also treated many attack related casualties, reported in 1942 that ether anaesthesia by the drop method, lends itself well to this type of surgery. It has the advantage of safety and in addition, [...] it may be given by those with little training.

Looking at the files released 50 years after the event, it becomes clear that the stories about the large mortality due to barbiturates were nothing but exaggerated scare stories.

  • Thiopental is a barbiturate that is administered intravenously for the induction of general anesthesia or for the production of complete anesthesia of short duration.
  • It is also used for hypnosis and for the control of convulsive states.
  • It has been used in neurosurgical patients to reduce increased intracranial pressure.
  • It does not produce any excitation but has poor analgesic and muscle relaxant properties.
  • Small doses have been shown to be anti-analgesic and lower the pain threshold.
  • Belongs to the class of organic compounds known as thiobarbituric acid derivatives.

Sodium thiopental (also known as Sodium Pentothal, thiopental) was discovered in 1930s by investigators working for Abbott Laboratories.
  • Thiopental sodium was used for the induction of general anesthesia and is used as an adjunct to provide hypnosis during balanced anesthesia with other anesthetic agents, including analgesics and muscle relaxants.
  • Thiopental sodium was also used as an adjunct for control of convulsive disorders of various etiology, including those caused by local anesthetics.
  • Finally, thiopental sodium had been used to reduce the intracranial pressure in patients with increased intracranial pressure, if controlled ventilation is provided.

Thiopental sodium acts through the CNS with particular activity in the mesencephalic reticular activating system. It was shown, that mechanism of action of sodium thiopental via GABAA receptor. Thiopental binds at a distinct binding site associated with a Cl- ionopore at the GABAA receptor, increasing the duration of time for which the Cl- ionopore is open. The post-synaptic inhibitory effect of GABA in the thalamus is, therefore, prolonged.

Pentothal (Thiopental Sodium for Injection, USP) Indications:

  1. As the sole anesthetic agent for brief (15 minute) procedures
  2. For induction of anesthesia prior to administration of other anesthetic agents
  3. To supplement regional anesthesia
  4. To provide hypnosis during balanced anesthesia with other agents for analgesia or muscle relaxation
  5. For the control of convulsive states during or following inhalation anesthesia, local anesthesia, or other causes
  6. In neurosurgical patients with increased intracranial pressure, if adequate ventilation is provided
  7. For narcoanalysis and narcosynthesis in psychiatric disorders


Thiopental
Duration:

Barbiturate that kicks in very quickly, that is used to Anesthesia, Medical induced comas among other things.

RouteOnsetDurationAfter Effects
Tripsit Factsheets
Intravenous:0-2 minutes6-10 hours1-24 hours
Thiopental Duration
Avoid:
All other CNS depressants.

Interactions:

Drug Interactions (224) Alcohol/Food Interactions (1) Disease Interactions (8)

A total of 224 drugs are known to interact with Thiopental.

  • 10 major drug interactions
  • 181 moderate drug interactions
  • 33 minor drug interactions

Breastfeeding:

Summary of Use During Lactation:

Amounts of thiopental in milk are very small.

Existing data indicate that no waiting period is required before resuming breastfeeding after thiopental anesthesia. Breastfeeding can be resumed as soon as the mother has recovered sufficiently from general anesthesia to nurse. When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure.

Effects on Lactation and Breastmilk:
A randomized, but nonblinded, study in women undergoing cesarean section compared epidural anesthesia with bupivacaine to general anesthesia with intravenous thiopental 4 mg/kg and succinylcholine 1.5 mg/kg for induction followed by nitrous oxide and isoflurane. The time to the first breastfeed was significantly shorter (107 vs 228 minutes) with the epidural anesthesia than with general anesthesia. This difference was probably caused by the anesthesia's effects on the infant, because the Apgar and neurologic and adaptive scores were significantly lower in the general anesthesia group of infants.

Alternate Drugs to Consider:

(2011) Lethal injection drug production ends in the US:
Sole US sodium thiopental manufacturer, Hospira, has ceased manufacturing the drug used in administering death penalties. The US manufacturer, Hospira, says that it will stop production entirely after a bid to start making sodium thiopental in Italy stalled when the Rome government said it would only license manufacture if the drug was not used in executions. Hospira said it intended to manufacture sodium thiopental to serve hospitals but "could not prevent the drug from being diverted to departments of corrections for use in capital punishment procedures". "We cannot take the risk that we will be held liable by the Italian authorities if the product is diverted for use in capital punishment," the company said.

Sodium thiopental is an anaesthetic generally used before the administration of two other drugs that halt breathing and stop the heart. However, two states use sodium thiopental alone as it can kill on its own if used in high dosage. Oklahoma has started using pentobarbital, a drug used in doctor-assisted suicides in Oregon and by the Swiss euthanasia group, Dignitas.

(2011) No longer be available:
Sodium thiopental is an important and medically necessary anesthetic agent that has been used for years to induce anesthesia in patients undergoing surgical procedures. Although its use has decreased in recent years due to the introduction of newer medications, such as propofol, sodium thiopental is still considered a first-line anesthetic in many cases including those involving geriatric, neurologic, cardiovascular and obstetric patients, for whom the side effects of other medications could lead to serious complications.

The American Society of Anesthesiologists (ASA) and its members are extremely troubled to learn that the anesthetic drug, sodium thiopental (Pentothal), will no longer be available to patients in the United States due to the unfortunate circumstances in Italy that led the sole manufacturer, Hospira, to cease production of the drug.

(2012) Lethal Injection Challenges Continue Across the Country:
Sodium thiopental has been in short supply since the only U.S. manufacturer, Hospira, Inc., suspended production in 2010 due to concerns about its use in executions. In early 2011, Hospira announced it would halt production of sodium thiopental permanently. In medical procedures, the drug is primarily used to anesthetize surgical patients and induce medical comas. In executions by lethal injection, the drug is part of a three-drug cocktail: the sodium thiopental sedates prisoners before pancuronium bromide and potassium chloride are administered, paralyzing the muscles and stopping the heart.

The shortage has forced several states to find an alternative to sodium thiopental or sources of the drug outside of the United States. In the past year, the Drug Enforcement Agency has seized drug supplies from Alabama, Georgia, Tennessee, and Kentucky because of illegal importation and has raised concerns about how the drugs were manufactured. Additionally, in December 2011, the European Union banned the export of all lethal injection drugs, including sodium thiopental, to the United States. Some states have attempted to explore alternative foreign sources, but none has been approved by the FDA.

EMC PDF Thiopental

HMA PDF Thiopental

Sodium thiopental:

Sodium thiopental was a core medicine in the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system, but was supplanted by propofol

  • A rapid-onset short-acting barbiturate general anesthetic
  • Has been used commonly in the induction phase of general anesthesia
  • An analog of pentobarbital
  • Discovered in the early 1930s
  • Although thiopental abuse carries a dependency risk, its recreational use is rare.
  • A normal dose of sodium thiopental (usually 4-6 mg/kg) given to a pregnant woman for operative delivery (caesarian section) rapidly makes her unconscious, but the baby in her uterus remains conscious. However, larger or repeated doses can depress the baby's consciousness.
  • In addition to anesthesia induction, sodium thiopental was historically used to induce medical comas. It has now been superseded by drugs such as propofol because their effects wear off more quickly than thiopental.
  • In veterinary medicine, sodium thiopental is used to induce anesthesia in animals.
  • Psychiatrists have used thiopental to desensitize patients with phobias and to 'facilitate the recall of painful repressed memories.'
  • Sodium thiopental is used intravenously for the purposes of euthanasia. In both Belgium and the Netherlands, where active euthanasia is allowed by law, the standard protocol recommends sodium thiopental as the ideal agent to induce coma, followed by pancuronium bromide to paralyze muscles and stop breathing. Thiopental is used in 34 states of the US to execute prisoners by lethal injection. A very large dose is given to ensure rapid loss of consciousness.
  • Thiopental is still used in places such as India as a truth serum to weaken the resolve of a subject and make the individual more compliant to pressure.

Following intravenous injection, the drug rapidly reaches the brain and causes unconsciousness within 30-45 seconds. At one minute, the drug attains a peak concentration of about 60% of the total dose in the brain. Thereafter, the drug distributes to the rest of the body, and in about 5-10 minutes the concentration is low enough in the brain that consciousness returns.

It was previously the first of three drugs administered during most lethal injections in the United States, but the US manufacturer Hospira stopped manufacturing the drug and the European Union banned the export of the drug for this purpose.

Thiopental is famously associated with a number of anesthetic deaths in victims of the attack on Pearl Harbor. These deaths, relatively soon after the drug's introduction, were said to be due to excessive doses given to shocked trauma patients. However, recent evidence available through freedom of information legislation was reviewed in the British Journal of Anaesthesia, which has suggested that this story was grossly exaggerated. Of the 344 wounded that were admitted to the Tripler Army Hospital, only 13 did not survive, and it is unlikely that thiopentone overdose was responsible for more than a few of these.

  
Thiopental - Indications, Dosage, Side Effects and Precautions - Latest prescription information about Thiopental. Learn how to pronounce the drug's name, its indications, dosage, how to take, when to take, when not to take, side effects, special precautions ...
Thursday February 10, 2011 - medindia.net

Does Thiopental Sodium Rectal Interact with other Medications? - These medications are not usually taken together. Consult your healthcare professional (e.g., doctor or pharmacist) for more in formation. Sorry, we have no data ...
Friday November 17, 2017 - webmd.com

Intraval Sodium (1g) (Thiopental Sodium) Drug Price and Information - Medindia updates the prices regularly, however, there may be slight discrepancies in the prices displayed. This can be due to the following reasons:Medindia updates the prices regularly, however ...
Sunday March 18, 2018 - medindia.net

Lethal Injection for Execution: Chemical Asphyxiation? - This hypothesis has been supported by findings of low postmortem blood thiopental levels and eyewitness accounts of problematic executions. Herein we report evidence that the design of the drug ...
Saturday February 04, 2023 - medscape.com

Thiopental Sodium - Percent Composition: C 49.99%, H 6.48%, N 10.60%, Na 8.70%, O 12.11%, S 12.13% ...
Sunday May 12, 2019 - rsc.org

Death row inmate's last words were 'I'm ready to fly' before lethal injection - Ruiz, who was Hispanic, received a lethal injection at the state penitentiary in Huntsville yesterday evening. ‘I would like to apologise to Mark and the Nix family for taking him away from you,’ Ruiz ...
Thursday February 02, 2023 - msn.com

Global Thiopental Sodium Market Size 2023 Research Report by Market Share, Manufactures, Drivers, Top Leading Countries, Trends and Forecast to 2028 - Global “Thiopental Sodium Market” 2023-2028 research report give information data on company profiles of leading players of the keyword market including company details, business overview ...
Sunday January 08, 2023 - marketwatch.com

Arizona executions on hold amid review ordered by governor - Arizona’s new governor has ordered a review of the state's death penalty protocols due to its history of mismanaging executions, leading the state’s attorney general to hold off on seeking executions ...
Sunday January 22, 2023 - lasvegassun.com

Arizona executions paused: Commissioner to review state's death penalty process - Executions in Arizona have been put on hold after Gov. Katie Hobbs issued an executive order that she says will improve and provide more transparency into the state's death penalty process.
Friday January 20, 2023 - fox10phoenix.com

Shakespeare Is Just Collateral Damage for Transphobic Laws Against Drag Shows - Not even Shakespeare would be safe, as P. M. Carpenter helpfully points out. The law... "would apply to any show whose 'main aspect [is] a performer which exhibits a gender identity that is different ...
Thursday January 26, 2023 - esquire.com

Lethal Injection for Execution: Chemical Asphyxiation? - Each drug used, the ultrashort-acting barbiturate thiopental, the neuromuscular blocker pancuronium bromide, and the electrolyte potassium chloride, was expected to be lethal alone, while the ...
Thursday March 24, 2022 - medscape.com

Arizona executions are on hold until a review ordered by the governor is completed - The review will examine Arizona's procurement process for lethal injection drugs and gas, execution procedures, news organizations' access to executions and training of staff to carry out executions.
Friday January 20, 2023 - tspr.org

  
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