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Drug overview for METHOHEXITAL SODIUM (methohexital sodium):
Generic name: METHOHEXITAL SODIUM
Drug class: Intravenous Anesthetics
Therapeutic class: Anesthetics
Methohexital sodium is a barbiturate anesthetic.
Methohexital sodium is used IV in adults for induction of general anesthesia (prior to administration of other anesthetic agents). The drug also is used for inducing anesthesia and supplementing subpotent anesthetic agents (e.g., nitrous oxide and oxygen) either alone for short-term procedures or with other parenteral drugs (e.g., opiate analgesics) for longer procedures. In addition, methohexital is used for IV anesthesia during short surgical, diagnostic, or therapeutic procedures, associated with minimum painful stimuli, and for induction of a hypnotic state.
Preanesthetic agents usually are recommended when methohexital sodium is used; the drug is not inhibited by the usual preanesthetic medications. In pediatric patients older than 1 month of age, methohexital sodium may be used IM or rectally for induction of anesthesia, prior to administration of other anesthetic agents, for supplementing subpotent inhalation anesthetic agents during short surgical procedures, and for anesthesia during short surgical, diagnostic, or therapeutic procedures, associated with minimum painful stimuli.
Generic name: METHOHEXITAL SODIUM
Drug class: Intravenous Anesthetics
Therapeutic class: Anesthetics
Methohexital sodium is a barbiturate anesthetic.
Methohexital sodium is used IV in adults for induction of general anesthesia (prior to administration of other anesthetic agents). The drug also is used for inducing anesthesia and supplementing subpotent anesthetic agents (e.g., nitrous oxide and oxygen) either alone for short-term procedures or with other parenteral drugs (e.g., opiate analgesics) for longer procedures. In addition, methohexital is used for IV anesthesia during short surgical, diagnostic, or therapeutic procedures, associated with minimum painful stimuli, and for induction of a hypnotic state.
Preanesthetic agents usually are recommended when methohexital sodium is used; the drug is not inhibited by the usual preanesthetic medications. In pediatric patients older than 1 month of age, methohexital sodium may be used IM or rectally for induction of anesthesia, prior to administration of other anesthetic agents, for supplementing subpotent inhalation anesthetic agents during short surgical procedures, and for anesthesia during short surgical, diagnostic, or therapeutic procedures, associated with minimum painful stimuli.
DRUG IMAGES
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The following indications for METHOHEXITAL SODIUM (methohexital sodium) have been approved by the FDA:
Indications:
Administration of general anesthesia
Professional Synonyms:
None.
Indications:
Administration of general anesthesia
Professional Synonyms:
None.
The following dosing information is available for METHOHEXITAL SODIUM (methohexital sodium):
Dosage of methohexital sodium is highly individualized, and the drug should be administered only by those completely familiar with its quantitative differences from other barbiturate anesthetics. Dosage of the drug is expressed in terms of the sodium salt.
In addition, dosage of induction anesthetics should be adjusted according to response, age, weight, gender, physical and clinical status, underlying pathologic conditions (e.g., shock, intestinal obstruction, malnutrition, anemia, burns, advanced malignancy, ulcerative colitis, uremia, alcoholism), and the type and amount of premedication or concomitant medication(s). Dosages of the drug also should be titrated to clinical effect.
In addition, dosage of induction anesthetics should be adjusted according to response, age, weight, gender, physical and clinical status, underlying pathologic conditions (e.g., shock, intestinal obstruction, malnutrition, anemia, burns, advanced malignancy, ulcerative colitis, uremia, alcoholism), and the type and amount of premedication or concomitant medication(s). Dosages of the drug also should be titrated to clinical effect.
No enhanced Administration information available for this drug.
No dosing information available.
No generic dosing information available.
The following drug interaction information is available for METHOHEXITAL SODIUM (methohexital sodium):
There are 0 contraindications.
There are 1 severe interactions.
These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.
| Drug Interaction | Drug Names |
|---|---|
| Sodium Oxybate/Agents that May Cause Respiratory Depression SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Oxybate by itself may be associated with severe somnolence or respiratory depression. Concurrent use with other CNS depressants may further increase the risk for respiratory depression or loss of consciousness.(1-3) CLINICAL EFFECTS: Concurrent use of sodium oxybate and sedative hypnotics or alcohol may further increase the risk for profound sedation, respiratory depression, coma, and/or death.(1,2) Fatalities have been reported.(3) PREDISPOSING FACTORS: Based upon FDA evaluation of deaths in patients taking sodium oxybate, risk factors may include: use of multiple drugs which depress the CNS, more rapid than recommended oxybate dose titration, exceeding the maximum recommended oxybate dose, and prescribing for unapproved uses such as fibromyalgia, insomnia or migraine. Note that in oxybate clinical trials for narcolepsy 78% - 85% of patients were also receiving concomitant CNS stimulants.(1-3) PATIENT MANAGEMENT: Avoid use of concomitant opioids, benzodiazepines, sedating antidepressants, sedating antipsychotics, general anesthetics, or muscle relaxants, particularly when predisposing risk factors are present. If combination use is required, dose reduction or discontinuation of one or more CNS depressants should be considered. If short term use of an opioid or general anesthetic is required, consider interruption of sodium oxybate treatment.(1,2) Respiratory depression can occur at any time during opioid therapy, especially during therapy initiation and following dosage increases. Consider this risk when using concurrently with other agents that may cause CNS depression.(4) Discuss naloxone with all patients when prescribing or renewing an opioid analgesic or medicine to treat opioid use disorder (OUD). Consider prescribing naloxone to patients prescribed medicines to treat OUD or opioid analgesics (such as those taking CNS depressants) who are at increased risk of opioid overdose and when a patient has household members/close contacts at risk for accidental overdose.(5) DISCUSSION: The FDA evaluated sodium oxybate postmarket fatal adverse event reports from the FDA Adverse Event Reporting System(AERS)and from the manufacturer. Although report documentation was not always optimal or complete, useful information was obtained. Factors which may have contributed to fatal outcome: concomitant use of one or more drugs which depress the CNS, more rapid than recommended oxybate dose titration, exceeding the maximum recommended oxybate dose, and prescribing for unapproved uses such as fibromyalgia, insomnia or migraine. Many deaths occurred in patients with serious psychiatric disorders such as depression and substance abuse. Other concomitant diseases may have also contributed to respiratory and CNS depressant effects of oxybate.(3) |
LUMRYZ, LUMRYZ STARTER PACK, SODIUM OXYBATE, XYREM, XYWAV |
There are 1 moderate interactions.
The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.
| Drug Interaction | Drug Names |
|---|---|
| Anesthesia Agents/GLP-1 Receptor Agonists SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: GLP-1 receptor agonists can cause delayed gastric emptying.(1,2) CLINICAL EFFECTS: Gastric contents may remain in the stomach after preoperative fasting, which could increase the risk of regurgitation and aspiration.(1,2) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The American Society of Anesthesiologists (ASA) recommends the following for patients receiving elective procedures: - For patients on daily dosing, consider holding GLP-1 agonists on the day of the procedure. For patients on weekly dosing, consider holding GLP-1 agonists a week prior to the procedure. - Consult an endocrinologist for patients taking GLP-1 agonists for diabetes management if the GLP-1 agonist is held longer than the dosing schedule to avoid hyperglycemia. - For patients requiring urgent or emergent procedures, proceed and treat the patient as 'full stomach.'(3) DISCUSSION: In one case report, a 31-year-old patient taking semaglutide followed preoperative fasting guidelines but food residue was discovered upon endoscopy, leading to cancellation of the surgical procedure.(4) In a case report, a semaglutide-treated patient experienced regurgitation upon induction of general anesthesia despite a 20 hour preoperative fasting period. The patient received semaglutide two days before the scheduled procedure.(5) A case report of a 42-year-old patient after fasting for 18 hours showed substantial gastric content upon endoscopy. The patient experienced intraoperative pulmonary aspiration of gastric contents which were suctioned from the trachea and bronchi using bronchoscopy.(6) |
BYDUREON BCISE, EXENATIDE, LIRAGLUTIDE, MOUNJARO, OZEMPIC, RYBELSUS, SAXENDA, SEMAGLUTIDE, SOLIQUA 100-33, TRULICITY, VICTOZA 2-PAK, VICTOZA 3-PAK, WEGOVY, XULTOPHY 100-3.6, ZEPBOUND |
The following contraindication information is available for METHOHEXITAL SODIUM (methohexital sodium):
Drug contraindication overview.
No enhanced Contraindications information available for this drug.
No enhanced Contraindications information available for this drug.
There are 1 contraindications.
Absolute contraindication.
| Contraindication List |
|---|
| Porphyria |
There are 4 severe contraindications.
Adequate patient monitoring is recommended for safer drug use.
| Severe List |
|---|
| Hypotension |
| Severe hepatic disease |
| Shock |
| Status asthmaticus |
There are 7 moderate contraindications.
Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.
| Moderate List |
|---|
| Chronic heart failure |
| Chronic obstructive pulmonary disease |
| Focal epilepsy |
| Kidney disease with reduction in glomerular filtration rate (GFr) |
| Morbid obesity |
| Severe anemia |
| Severe uncontrolled hypertension |
The following adverse reaction information is available for METHOHEXITAL SODIUM (methohexital sodium):
Adverse reaction overview.
No enhanced Common Adverse Effects information available for this drug.
No enhanced Common Adverse Effects information available for this drug.
There are 13 severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
| None. |
Dyspnea Respiratory depression Thrombophlebitis |
| Rare/Very Rare |
|---|
|
Abnormal hepatic function tests Acute respiratory failure Anaphylaxis Apnea Bronchospastic pulmonary disease Cardiac arrest Hypotension Radial nerve palsy Seizure disorder Vasodilation of blood vessels |
There are 17 less severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
| None. |
Cough Hiccups Muscle fasciculation |
| Rare/Very Rare |
|---|
|
Acute abdominal pain Chills Delirium Drowsy Erythema Headache disorder Injection site sequelae Laryngismus Nausea Pruritus of skin Rhinitis Sialorrhea Tachycardia Vomiting |
The following precautions are available for METHOHEXITAL SODIUM (methohexital sodium):
No enhanced Pediatric Use information available for this drug.
Contraindicated
Severe Precaution
Management or Monitoring Precaution
Contraindicated
| None |
Severe Precaution
| None |
Management or Monitoring Precaution
| None |
Reproduction studies in rabbits and rats using methohexital sodium doses 4 and 7 times the usual human dose, respectively, have not revealed evidence of harm to the fetus. The manufacturer states that although the drug has been used in women undergoing delivery by cesarean section, it should be considered that methohexital readily and rapidly crosses the placenta. There are no adequate and controlled studies to date using methohexital sodium in pregnant women, and the drug should be used during pregnancy only when clearly needed.
Based on animal data, repeated or prolonged use of general anesthetics and sedation drugs, including methohexital sodium, during the third trimester of pregnancy may result in adverse neurodevelopmental effects in the fetus. The clinical relevance of these animal findings to humans is not known; the potential risk of adverse neurodevelopmental effects should be considered and discussed with pregnant women undergoing procedures requiring general anesthetics and sedation drugs. (See Cautions: Pediatric Precautions.)
Based on animal data, repeated or prolonged use of general anesthetics and sedation drugs, including methohexital sodium, during the third trimester of pregnancy may result in adverse neurodevelopmental effects in the fetus. The clinical relevance of these animal findings to humans is not known; the potential risk of adverse neurodevelopmental effects should be considered and discussed with pregnant women undergoing procedures requiring general anesthetics and sedation drugs. (See Cautions: Pediatric Precautions.)
Because barbiturates are distributed into milk, the drug should be used with caution in nursing women.
No enhanced Geriatric Use information available for this drug.
The following prioritized warning is available for METHOHEXITAL SODIUM (methohexital sodium):
No warning message for this drug.
No warning message for this drug.
The following icd codes are available for METHOHEXITAL SODIUM (methohexital sodium)'s list of indications:
No ICD codes found for this drug.
No ICD codes found for this drug.
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