Is it Safe to Combine Barbiturates and Alcohol?

Barbiturates are derivatives of barbituric acid and are easily absorbed by both oral and intramuscular injections. Its main role is to inhibit the central nervous system. It is commonly used clinically for sedation and hypnosis, anticonvulsant, antiepileptic and pre-anesthetic administration. Note: Easy to develop tolerance and addiction. Adverse reactions include dizziness, weakness, nausea and vomiting. It can also suppress the respiratory center. Medications can be given for large doses of poisoning. ^[1]

Barbiturates

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Barbiturates are derivatives of barbituric acid and are easily absorbed by both oral and intramuscular injections. Its main role is to inhibit the central nervous system. It is commonly used clinically for sedation and hypnosis, anticonvulsant, antiepileptic and pre-anesthetic administration. Note: Easy to develop tolerance and addiction. Adverse reactions include dizziness, weakness, nausea and vomiting. It can also suppress the respiratory center. Medications can be given for large doses of poisoning. ^[1]

Barbiturates are the main class of hypnotics. It is a derivative of barbituric acid, and its sodium salt is easily soluble in water.

Classification according to the length of its hypnotic effect: long-acting type, which lasts 6-8 hours, such as barbital and phenobarbital; medium-acting type, 4-6 hours, such as isoprene barbitur and pentobarbital; Short-acting, 2-3 hours, such as Scobarbital. Thiopental sodium has a shorter action time and can be used as an intravenous anesthetic. It is an ultra-short-acting class.

Barbiturates are a group of central inhibitors obtained by substituting barbituric acid at the c5 position. Substituents that are long and branched (such as isoprene barbitur) or double bonds (such as sercobarbital) are strong and short; substituted with a benzene ring (such as

Inhibition of the central nervous system is generally proportional to the dose. Small doses have a sedative effect, medium doses have a hypnotic effect, and large doses have an anesthetic effect. Overdose can cause coma and serious death; long-term use can be addictive.

Barbitur induces liver enzymes to cause its rapid destruction, and also accelerates the metabolism of other drugs, such as coumarins, chlorpromazine, chloramphenicol, doxycycline, corticosteroids, androgens, estrogen, and metronid Azole, which affects the efficacy of these drugs. Barbiturates strengthen the inhibitory effects of Titipip, and when combined with alcohol, they strengthen each other. These drugs make asthma worse.

Barbiturates can cause porphyrin crisis. The use of barbiturates in the elderly is more likely to cause a significant reduction in serum calcium than diazepam. Barbiturate also enhances cholesterol metabolism. Phenobarth is used to treat infantile epilepsy, and serum phospholipids and low and high density lipoproteins are increased. Muscle necrosis occasionally occurs after barbiturate injection, followed by myosinemia.

1. Hypnotic doses of barbiturates can cause dizziness and drowsiness, and poor coordination of fine movements. Can cause severe allergic reactions such as exfoliative dermatitis. Moderate dose can slightly inhibit the respiratory center, severe pulmonary dysfunction and head injury caused by brain injury are disabled. Its medicinal enzyme induction can accelerate the metabolism of other drugs and affect the efficacy.

2. Continuous long-term service of barbiturates can cause habituation. Sudden drug withdrawal is prone to "bounce". At this time, the fast-moving eye sleep time prolonged, and nightmares increased, forcing patients to continue medication and eventually addiction. Withdrawal after addiction, withdrawal symptoms are obvious, manifested as agitation, insomnia, anxiety, and even convulsions.

3. Rare vision involvement, changes in color vision, conjunctivitis, drooping eyelids, and diplopia.

4. Occasionally a rash may cause foaming damage. Liang Changli reported one case of dermatitis caused by phenobarbital, which recovered after discontinuation; the other case had exfoliative dermatitis after repeated administration of the drug, and died of liver and spleen damage. Fan Yulin reported 5 cases of exfoliative dermatitis caused by phenobarbital with a total dosage of 0.72 to 1.29g. Most patients had fever, rash and mucosal and liver damage; 3 cases of superficial lymph node enlargement; Cases of death. In addition, 7 patients had exfoliative dermatitis due to phenobarbital.

Acute intermittent porphyria is contraindicated because it can induce a crisis. This drug is relatively contraindicated in patients with severe pulmonary insufficiency. The use of phenobarbital in patients with elevated intracranial pressure is dangerous. Initially, the intracranial pressure decreases, and then it suddenly increases and causes death. The t1 / z of barbiturate in patients with liver necrosis is significantly prolonged. If this medicine is necessary, the dose should be reduced. No dose adjustment is needed for kidney disease, hepatitis, or the elderly.

Those who are accustomed to using this medicine suddenly stop taking it is dangerous. In the early stage, fear, muscle weakness, tremor, orthostatic prostration, sleep disturbance, and loss of appetite may appear. Spasms and delirium can occur after 3 to 8 days of withdrawal. The danger is misdiagnosed as epilepsy and given barbiturates.

Teratogenic patients have not been reported, but because of its inhibitory effect, the use of this drug in pregnant women is opposed. If you take this medicine in the near-term or lactation period, your baby will be sedated.

The elderly often have insomnia such as difficulty falling asleep, waking up at night or waking up early in the morning. To deal with this, in theory, long-term phenobarbital should be used. However, clinical experience shows that it is best to avoid the use of barbiturates including phenobarbital in insomnia for the following reasons:

First, some older people have poor tolerance to barbiturates, which can often cause severe drowsiness and depression.

Second, elderly people with chronic obstructive pulmonary disease (emphysema, bronchial asthma) are often accompanied by severe pulmonary insufficiency. Even small doses of barbiturates can cause severe hypoxia and carbon dioxide retention. In severe cases, it can cause pulmonary edema or respiratory paralysis, which is contraindicated.

Third, the elderly have varying degrees of renal dysfunction, and phenobarbital is excreted by the kidney in its original form, which tends to slow drug excretion and prolong plasma half-life. Therefore, the use of barbiturates in the elderly is likely to cause conscious disturbances and ataxia. Symptoms of poisoning. Fourth, a few elderly people may experience some abnormal reactions after using this kind of drugs, that is, they show excitement instead of inhibition, such as irritability, insomnia, nightmares, and even mental disorders.

In summary, it is better for the elderly to use or not to use barbiturates with caution. In fact, there are many causes of insomnia. For insomnia, the first treatment is to eliminate the causes of insomnia. In comparison, diazepam and nitro-diazepam are safer and more effective for the treatment of elderly insomnia, and can replace barbiturates.

New Pharmacology

Phenobarbital, phenobarbital scopolamine, phenobarbital sodium, sercobarbitone sodium, isoprene barbitur