Phenobarbital

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Death may occur when barbiturates are combined with depressants such as opiates, benzodiazepines, gabapentinoids, thienodiazepines, alcohol or other GABAergic substances.[1]

It is strongly discouraged to consume moderate to heavy dosages of these substances together.

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Summary sheet: Phenobarbital
Phenobarbital
Phenobarbital.svg
Chemical Nomenclature
Common names Phenobarbital, phenobarbitone, Luminal, phenobarb
Systematic name 5-Ethyl-5-phenyl-1,3-diazinane-2,4,6-trione
Class Membership
Psychoactive class Depressant
Chemical class Barbiturate
Routes of Administration

WARNING: Always start with lower doses due to differences between individual body weight, tolerance, metabolism, and personal sensitivity. See responsible use section.



Oral
Dosage
Threshold 25 - 50 mg
Light 50 - 100 mg
Common 100 - 150 mg
Strong 150 - 300 mg
Heavy 300 mg +
Duration
Onset 15 - 60 minutes
Peak 4 - 6 hours
After effects 1 - 48 hours









DISCLAIMER: PW's dosage information is gathered from users and resources for educational purposes only. It is not a recommendation and should be verified with other sources for accuracy.

Phenobarbital, also known as phenobarbitone in British English and by the brand name Luminal, is a long-acting psychoactive drug of the barbiturate class which produces powerful anxiolytic, hypnotic, muscle relaxant and amnesic effects. Phenobarbital is used medically as an anticonvulsant, and occasionally in the short term treatment of insomnia. Phenobarbital works in a similar fashion to benzodiazepines, however barbiturates bind to a distinct allosteric site on the GABAA receptor.

Compared to other barbiturates such as pentobarbital, phenobarbital has an extremely long duration of action, similar to diazepam, which makes it ideal for the treatment of epilepsy.

Phenobarbital, like most long-acting barbiturates, can be deemed moderately addictive. The abrupt discontinuation of phenobarbital in dependent individuals may be life-threatening and lead to seizures and even death[2]. Phenobarbital drastically enhances the effects of other depressants such as alcohol, and concurrent use may lead to respiratory depression and possibly death.

Chemistry

Phenobarbital is a drug of the barbiturate class. Barbiturate drugs contain the backbone of barbituric acid. Phenobarbital has a 5-ethyl, 5-phenyl substitution on the 5-position of the barbituric acid backbone which gives it its unique pharmacological effects. Phenobarbital empirical formula is C12H12N2O3 and has a molar mass of 232.235 grams per mole.

Pharmacology

Barbiturates behave similarly to benzodiazepines. Phenobarbital binds to an allosteric site on the GABAA receptor and potentiates the effects of the endogenous ligand, gamma-aminobutyric acid. When barbiturates bind to the GABAA receptor, it causes the ion pore to open for extended periods of time, causing an increase of intracellular chlorine ion concentrations. As this site is the most prolific inhibitory receptor set within the brain, its modulation results in the sedating (or calming effects) of barbiturates on the nervous system.

Phenobarbital has a bioavailability of around 95%. 20%-45% of phenobarbital will bind to proteins. Phenobarbital's biological half life is 53-118 hours. It is metabolized by the liver and excreted by the kidneys and intestines.

Subjective effects

The effects listed below are based upon the subjective effects index and personal experiences of PsychonautWiki contributors. These effects should be taken with a grain of salt and will rarely (if ever) occur all at once, but heavier doses will increase the chances of inducing a full range of effects. Likewise, adverse effects become much more likely on higher doses and may include serious injury or death.

Physical effects
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Visual effects
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Cognitive effects
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Experience reports

There are currently no anecdotal reports which describe the effects of this compound within our experience index. Additional experience reports can be found here:

Toxicity and harm potential

Radar plot showing relative physical harm, social harm, and dependence of barbiturates in comparison to other drugs.[4]

Phenobarbital likely has moderate toxicity relative to dose. However, phenobarbital is potentially lethal when mixed with depressants like alcohol or opioids. Phenobarbital has a higher risk of death or serious adverse effects associated with concurrent depressant use than other drugs such as benzodiazepines. There have been studies linking the use of barbiturates, particularly phenobarbital, with the development of cancer [5].

It is strongly recommended that one use harm reduction practices when using this drug.

Tolerance and addiction potential

Phenobarbital is extremely physically and psychologically addictive. Barbiturate withdrawal is medically serious and can potentially cause a life-threatening withdrawal syndrome that can cause seizures, psychosis, and death. Drugs which lower the seizure threshold such as tramadol and amphetamine should be avoided during withdrawal.

Tolerance will develop to the sedative-hypnotic effects of phenobarbital after prolonged use. It is unknown exactly how long it takes for tolerance to reach baseline. Phenobarbital presents cross-tolerance with all barbiturates, meaning that after its consumption all barbiturates will have a reduced effect.

Dangerous interactions

Although many drugs are safe on their own, they can become dangerous and even life-threatening when combined with other substances. The list below contains some common potentially dangerous combinations, but may not include all of them. Certain combinations may be harmless in low doses of each but still increase the potential risk of death. Independent research should always be done to ensure that a combination of two or more substances is safe before consumption.

  • Depressants (1,4-Butanediol, 2-methyl-2-butanol, alcohol, barbiturates, GHB/GBL, methaqualone, opioids) - This combination can result in dangerous or even fatal levels of respiratory depression. These substances potentiate the muscle relaxation, sedation and amnesia caused by one another and can lead to unexpected loss of consciousness at high doses. There is also an increased risk of vomiting during unconsciousness and death from the resulting suffocation. If this occurs, users should try to fall asleep in the recovery position or have a friend move them into it.
  • Dissociatives - This combination can lead to an increased risk of vomiting during unconsciousness and death from the resulting suffocation. If this occurs, users should attempt to fall asleep in the recovery position or have a friend move them into it.
  • Stimulants - It is unsafe to combine barbiturates with stimulants due to the risk of excessive intoxication. Stimulants decrease the sedative effect of barbiturates, which is the main factor most people consider when determining their level of intoxication. Once the stimulant wears off, the effects of barbiturates will be considerably increased, leading to intensified disinhibition as well as other effects. If combined, one should strictly limit themselves to only dosing a certain amount of barbiturates per hour. This combination can also potentially result in severe dehydration if hydration is not monitored.

Overdose

Barbiturate overdose may occur when a barbiturate is taken in extremely heavy quantities or concurrently with other depressants. This is particularly dangerous with other GABAergic depressants such as benzodiazepines and alcohol since they work in a similar fashion, but bind to distinct allosteric sites on the GABAA receptor, thus their effects potentiate one another. Benzodiazepines increase the frequency in which the chlorine ion pore opens on the GABAA receptor while barbiturates increase the duration in which they are open, meaning when both are consumed, the ion pore will open more frequently and stay open longer[6]. Barbiturate overdose is a medical emergency that may lead to a coma, permanent brain injury or death if not treated promptly and properly. Barbiturate overdose has an increased frequency of serious adverse effects when compared to other depressants.

Symptoms of a barbiturate overdose may include severe thought deceleration, slurred speech, confusion, delusions, respiratory depression, coma or death[7].

Legal issues

  • International: Internationally, phenobarbital is a Psychotropic Schedule IV under the UN Convention on Psychotropic Substances[8].
  • United States: In the United States, phenobarbital is a Schedule IV Controlled Substance[9].
  • United Kingdom: In the United Kingdom, phenobarbitone is a Class B drug[10].
  • Australia: In Australia, phenobarbitone is an S4 Prescription Only Drug[11].
  • Germany: In Germany, phenobarbital is an Anlage III Prescription Only drug[12].
  • Canada: In Canada, phenobarbital is a Schedule IV drug[13].

See also

External links

References