Formulary
Thiopental sodium: Indications, Dosing, Side Effects and Interactions
Thiopental sodium clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Thiopental sodium: Indications, Dosing, Side Effects and Interactions
Thiopental sodium clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Status epilepticus (only if other measures fail)**
- **Adult** (By Slow Intravenous Injection): 75-125 mg for 1 dose, to be administered as a 2.5% (25 mg/mL) solution.
**Induction of anaesthesia**
- **Adult** (By Slow Intravenous Injection): Initially 100-150 mg, to be administered over 10-15 seconds usually as a 2.5% (25 mg/mL) solution, followed by 100-150 mg after 0.5-1 minute if required, dose to be given in fit and premedicated adults; debilitated patients or adults over 65 years may require a lower dose or increased administration time, alternatively initially up to 4 mg/kg (max. per dose 500 mg).
**Anaesthesia of short duration**
- **Adult** (By Slow Intravenous Injection): Initially 100-150 mg, to be administered over 10-15 seconds usually as a 2.5% (25 mg/mL) solution, followed by 100-150 mg after 0.5-1 minute if required, dose to be given in fit and premedicated adults; debilitated patients or adults over 65 years may require a lower dose or increased administration time, alternatively initially up to 4 mg/kg (max. per dose 500 mg).
**Reduction of raised intracranial pressure if ventilation controlled**
- **Adult** (By Slow Intravenous Injection): 1.5-3 mg/kg, repeated if necessary.
**Prolonged status epilepticus for thiopental sodium**
- **Neonate** (Initially by slow intravenous injection): Initially up to 2 mg/kg, then (by continuous intravenous infusion) up to 8 mg/kg/hour, adjusted according to response.
- **Child** (Initially by slow intravenous injection): Initially up to 4 mg/kg, then (by continuous intravenous infusion) up to 8 mg/kg/hour, adjusted according to response.
**Induction of anaesthesia for thiopental sodium**
- **Neonate** (By slow intravenous injection): Initially up to 2 mg/kg, then 1 mg/kg, repeated if necessary; maximum 4 mg/kg per course.
- **Child** (By slow intravenous injection): Initially up to 4 mg/kg, then 1 mg/kg, repeated if necessary; maximum 7 mg/kg per course.
Cautions
Acute circulatory failure (shock); avoid intra-arterial injection; cardiovascular disease; elderly; hypovolaemia; reconstituted solution is highly alkaline (extravasation causes tissue necrosis and severe pain); respiratory diseases (avoid in acute asthma)
Contraindications
Acute porphyrias ; myotonic dystrophy
Side effects
Common or very common Arrhythmia; myocardial contractility decreased Frequency not known Appetite decreased; circulatory collapse; cough; electrolyte imbalance; extravasation necrosis; hypotension; respiratory disorders; skin eruption; sneezing
Interactions
**Other interactions (21):**
- Gastrointestinal drugs: metoclopramide and droperidol reduce the dose of thiopental sodium required to induce anaesthesia.
- Bradycardia occurring during anaesthetic induction with thiopental has been reported in patients also receiving fentanyl.
- Benzodiazepines: midazolam potentiates the anaesthetic effects of thiopental sodium.
- Antibacterials: general anaesthetics possibly potentiate hepatotoxicity of isoniazid; effects of thiopental sodium enhanced by sulphonamides; hypersensitivity-like reactions can occur when general...
- Antidepressants: increased risk of arrhythmias and hypotension when general anaesthetics given with tricyclic antidepressants.
- Antipsychotics: patients being treated with phenothiazine antipsychotics may experience increased hypotension.
Pregnancy
May depress neonatal respiration when used during delivery.
Breast feeding
Breast-feeding can be resumed as soon as mother has recovered sufficiently from anaesthesia.
Hepatic impairment
Manufacturer advises caution. Dose adjustments Manufacturer advises dose reduction.
Renal impairment
Caution in severe impairment. M
Medicinal forms
Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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