Depending on their duration of action, barbiturates are classified as short, ultra short, intermediate and long-acting [1] [2]. Of these, the short and intermediate-acting barbiturates like pentobarbital and secobarbital [3] are often associated with withdrawal symptoms and signs. Barbiturate withdrawal can occur following the sudden cessation of the drug. This leads to a withdrawal syndrome identical to alcohol withdrawal with delirium tremens and can even be life-threatening in some patients.

Within a day after withdrawal of barbiturates, individuals develop restlessness, weakness, and tremulousness. Symptoms progressively increase on the second day with exaggerated deep tendon reflexes. Seizures can develop within 48 to 72 hours in patients who were on very high doses of barbiturates. This can even progress to status epilepticus and sometimes death [4]. Other clinical features like confusion, delirium, auditory and visual hallucinations, hyperpyrexia, circulatory collapse, and dehydration may occur between 48 to 120 hours after withdrawal [5].

Compared to alcohol withdrawal syndrome, barbiturate withdrawal is more variable and delayed [4] and patients can develop multiple seizures and delirium.

• Fever

  Some Withdrawal Symptoms Include: Tremors Difficulty sleeping Agitation Hallucinations Fever Fatigue Seizures Barbiturates can build up in the human body and as a person ages, the body becomes less able to cleanse itself of barbiturates. [avalonmalibu.com]

  Orally Drowsiness Headache Depression Excitement Joint or muscle pain Upset stomach Diarrhea Constipation Skin Rash Itching Sore throat Fever Easy bruising Bloody nose Unusual bleeding Confusion, hallucinations Weak or shallow breathing Slow heart rate [solutions-recovery.com]

  Barbiturates Bleeding sores on lips Chest pain Fever Muscle or joint pain Red, thickened, or scaly skin Skin rash or hives Sores, ulcers, or white spots in mouth (painful) Sore throat and/or fever Swelling of eyelids, face, or lips Wheezing or tightness [blog.palmpartners.com]

  Miscellaneous: pruritus, fever, earache, nasal congestion, tinnitus, euphoria, allergic reactions. Several cases of dermatological reactions, including toxic epidermal necrolysis and erythema multiforme, have been reported. [rxlist.com]

  Barbiturate withdrawal symptoms: Irritability Sleeplessness Restlessness Seizures Tremors Hallucinations Fever Sweating Delirium Cardiovascular collapse Severe anxiety Hypotension Mood disorders Accidental overdose Intentional suicide Death Most barbiturate [recoveryconnection.com]

• Unconsciousness

  Often used prior to surgery to induce temporary unconsciousness. Works by paralyzing, blocking pain, and disrupting short term memory of the surgery. Short Acting – This class takes effect after about 15 minutes. [coastlinerehabcenters.com]

  The ultra-short acting barbiturate of thiamylal is administered as an injection to induce unconsciousness in patients who are about to undergo surgery. [news-medical.net]

  Even relatively small doses of the drug can cause unconsciousness or death because they are powerful central nervous system depressants. Long-term, high-dosage use can create permanent movement disorders. [recoveryconnection.com]

  Taking an overdose of a barbiturate or taking alcohol or other CNS depressants with the barbiturate may lead to unconsciousness and possibly death. [mayoclinic.org]

  Barbiturates are still used in surgical anesthesia, especially to induce unconsciousness. Quick-acting thiopental (Pentothal) can produce unconsciousness within about a minute of intravenous injection. [promises.com]

• Hyperthermia

  If the syndrome is not recognized and correctly treated, hyperthermia, circulatory failure, and death may ensue. [ncbi.nlm.nih.gov]

  Anxiety Nausea Convulsions Shallow breathing and fainting Hallucinations Low blood pressure Lack of motor coordination Restlessness Weakness and fatigue Memory lapses Circulatory failure Psychosis Hostility Violent behavior Rhythmic intention tremor Hyperthermia [whitesandstreatment.com]

  Extremely high core body temperature called hyperthermia Failure of circulatory system to supply enough oxygen and nutrients to the tissues leading to death of different parts of the body This is a very serious stage of Barbiturate withdrawal. [addictionresource.com]

  If not treated immediately and comprehensively, a failure of the circulatory system, hyperthermia, and death are all possible. It is never safe to attempt to treat barbiturate withdrawal syndrome at home. [sunrisehouse.com]

• Nightmare

  Psychological symptoms include increased anxiety, panic attacks, rage, insomnia, nightmares, and depression. [intheknowzone.com]

  Between days three and eight, many people go through hallucinations, nightmares, insomnia, shortness of breath, and rapid heartbeats. Your medical professionals need to help you through this period, which usually lasts less than eight days. [crchealth.com]

  Because barbiturates decrease rapid eye movement during sleep, during which dreaming takes place, withdrawal can results in sleep disruptions such as nightmares, insomnia or vivid dreaming. [castlecraig.co.uk]

  Less common side effects include agitation, confusion, breathing difficulties, abnormally low blood pressure, nausea, vomiting, constipation, lower body temperature, decreased heart rate, movement difficulty, nightmares, anxiety, nervousness, mental depression [minddisorders.com]

  Sparkles is aware that in some countries (the US in particular) that money for treatment can be a bloody nightmare, but there re free hospitals there so she would head there. [drugs-forum.com]

• Surgical Procedure

  Tuinal slows the activity of your brain and nervous system allowing use as a sedative to relieve anxiety and induce sleep before a surgical procedure. Symptoms of Barbiturate withdrawal can be severe and may cause death. [solutions-recovery.com]

  Gaseous anesthetics are then used to maintain the patient's unconsciousness throughout the surgical procedure. Small does of barbiturates can make people feel relaxed, uninhibited, mildly euphoric, free of anxiety, and sleepy. [news-medical.net]

  Although barbiturates were once widely prescribed for anxiety and seizure disorders and used in surgical procedures as pre-anesthetics, their use has decreased significantly since 1970 following federal government regulations regarding their dispersion [drugabuse.com]

• Nausea

  Nausea. Vomiting. Anxiety. Tremors or shaking. Rapid heart rate. Seizures. [withdrawal.net]

  Symptoms are flu-like, and include gastrointestinal distress, anxiety, nausea, insomnia, muscle pain, fevers, sweating, and runny nose and eyes. [intheknowzone.com]

  According to the Diagnostic and Statistical manual of mental disorders (DSM) - 5, the criteria for barbiturate withdrawal are the following: Reduction or cessation of use of sedative Two or more of the following symptoms: autonomic hyperactivity, insomnia, nausea [symptoma.com]

  Barbiturates withdrawal symptoms can include restlessness, insomnia, weakness, dizziness, nausea, sweating and anxiety. There may be tremors, seizures, hallucinations and psychosis. Users may become hostile and violent. [patmoorefoundation.com]

  Barbiturate Side Effects Common side effects of barbiturates include: Sedation Dizziness and lightheadedness Headache Nausea or abdominal pain Barbiturate 'High' and Abuse Barbiturates can be habit-forming and addictive. [everydayhealth.com]

• Tachycardia

  Cardiovascular: tachycardia. Musculoskeletal: leg pain, muscle fatigue. Genitourinary: diuresis. Miscellaneous: pruritus, fever, earache, nasal congestion, tinnitus, euphoria, allergic reactions. [rxlist.com]

  Signs and symptoms associated with amphetamine use include mydriasis (dilated pupils), sweating, increased temperature, tachycardia (rapid pulse), and hypertension. [medical.tpub.com]

  Symptoms are similar to those of alcohol withdrawal and include tachycardia, seizures, tremor, and hyperreflexia. [emedicine.medscape.com]

  The reaction to disulfiram is characterized by headache, diaphoresis, tachycardia, nausea and vomiting, cardiovascular collapse, delirium, seizures and, occasionally, death. [aafp.org]

• Hypertension

  Signs and symptoms associated with amphetamine use include mydriasis (dilated pupils), sweating, increased temperature, tachycardia (rapid pulse), and hypertension. [medical.tpub.com]

  This drug is used for hypertension and to treat withdrawal from opiate narcotics. [encyclopedia.com]

  […] insomnia, elevated blood pressure and pulse (mild) Intense desire for drugs, muscle cramps, arthralgia, anxiety, nausea, vomiting, malaise PCP/psychedelics Days to weeks Days to weeks Hyperactivity, increased pain threshold, nystagmus, hyperreflexia, hypertension [aafp.org]

  […] biogenic amine (DA, NE, 5HT) reuptake Intoxication presentation mental status changes euphoria, psychomotor agitation, grandiosity, hallucinations (including tactile), paranoid ideations sympathetic activation ↓ appetite, tachycardia, pupillary dilation, hypertension [medbullets.com]

• Muscle Cramp

  During detox, other medical and psychiatric medications will be prescribed to control symptoms such as high heart rate and blood pressure, anxiety, depression, insomnia, muscle cramping, tremors, etc. [recoveryconnection.com]

  Opiates: Treatment may include the use of clonidine, which helps anxiety, sweating, irritability, muscle cramping and aching and runny nose, and/or buprenorphine or methadone, both of which can decrease the amount of time it takes to detoxify and also [verywell.com]

  Stopping cold turkey can result in life threatening seizures, tremors, and muscle cramps. Therefore, it is important to taper off benzodiazepines very slowly with professional help. [blog.palmpartners.com]

  cramps, arthralgia, anxiety, nausea, vomiting, malaise PCP/psychedelics Days to weeks Days to weeks Hyperactivity, increased pain threshold, nystagmus, hyperreflexia, hypertension and tachycardia, eyelid retraction (stare), agitation and hyperarousal [aafp.org]

  Withdrawal from Opiates such as Heroin and Morphine similarly involves physiologic symptoms and signs — diarrhea, gooseflesh, changes in pulse and blood pressure, muscle cramps, stomach cramps, and anxiety. [encyclopedia.com]

• Sweating

  The withdrawal symptoms of benzodiazepines include trouble sleeping, feelings of depression and sweating. If someone has become dependent on a benzodiazepine it is crucial that they do not suddenly stop therapy cold turkey. [blog.palmpartners.com]

  Barbiturates withdrawal symptoms can include restlessness, insomnia, weakness, dizziness, nausea, sweating and anxiety. There may be tremors, seizures, hallucinations and psychosis. Users may become hostile and violent. [patmoorefoundation.com]

  Symptoms are flu-like, and include gastrointestinal distress, anxiety, nausea, insomnia, muscle pain, fevers, sweating, and runny nose and eyes. [intheknowzone.com]

  Barbiturates Withdrawal Symptoms Withdrawal symptoms can include irritability, nervousness, delirium, sleeplessness, fainting, nausea, twitching, tremors, high blood pressure, sweating, seizures, muscle pain, confusion, and hallucinations. [castlecraig.co.uk]

  In addition to anxiety and hyperactivity, early barbiturate withdrawal symptoms can include sweating and a rapid heart rate. Inability to sleep, dizziness, and weakness are also clear indicators that a person is entering withdrawal. [wisegeek.com]

• Mood Swings

  Signs of barbiturate abuse include: Mood swings Anger Depression Poor judgment Lapses in memory Temper tantrums Disruptive vocalizations Noncompliance Property destruction Self-injury Lying, stealing, cheating Doctor shopping Barbiturate Withdrawal Symptoms [recoveryconnection.com]

  Some symptoms of barbiturate addiction are: A lack of motor coordination Fatigue Temper tantrums Mood swings Anger Disorderly vocalizations Non compliance Slurred speech Sedation Impairment of executive functions of the brain Reduced anxiety Depression [whitesandstreatment.com]

  With long term use there is risk of developing extreme mood swings, bouts of depression, impaired memory, erratic sleep schedules, insomnia, intense weakness and fatigue. [castlecraig.co.uk]

  Signs and Symptoms of Barbiturate Use Individuals who overuse barbiturates for prolong periods of time may suffer moderate to severe side effects including: hostility and mood swings, slurred speech and memory loss, lack of energy, difficulty breathing [soberforever.net]

  Cognitive and psychological effects : These effects include disorientation, confusion, slowed thinking, issues with memory, mood swings, issues with anxiety, depression, suicidal thoughts, and the presence of hallucinations or delusions. [deserthopetreatment.com]

• Anxiety Disorder

  First seen in medical use in the early 1900’s, the use of barbiturates were popular to treat anxiety disorders, seizure disorders, and insomnia. [lakeviewbehavioralhealth.com]

  Benzodiazepines such as Xanax, Valium, and Ativan have long been prescribed for substance abuse withdrawal, insomnia, anti depressant and anxiety disorders. Unfortunately, these depressants also have a high potential for abuse. [sunrisedetox.com]

  Someone that has a previous mental health history that includes anxiety disorders will likely experience exacerbated anxiety and panic during withdrawal. Barbiturate Detox Timeline and Protocol Barbiturates are classified by their speed of action. [detox.net]

  Another person may have been prescribed a tranquilizer for an anxiety disorder, for example. After a short period (sometimes as short as a week or two) of using the drug exactly as directed, tolerance develops. [intheknowzone.com]

  People who abuse barbiturates may suffer from co-occurring mental health conditions like anxiety disorders. [rehabs.com]

• Anger

  Signs of barbiturate abuse include: Mood swings Anger Depression Poor judgment Lapses in memory Temper tantrums Disruptive vocalizations Noncompliance Property destruction Self-injury Lying, stealing, cheating Doctor shopping Barbiturate Withdrawal Symptoms [recoveryconnection.com]

  Some symptoms of barbiturate addiction are: A lack of motor coordination Fatigue Temper tantrums Mood swings Anger Disorderly vocalizations Non compliance Slurred speech Sedation Impairment of executive functions of the brain Reduced anxiety Depression [whitesandstreatment.com]

  Being dependent on drugs can be a truly frightening experience, and addiction to Barbiturates can be a vicious cycle – when users start to detox from these drugs, they often feel a flood of uncomfortable emotions such as anxiety, sadness, guilt and anger [detoxtorehab.com]

  The potential withdrawal symptoms include dysphoric or depressed mood; insomnia; irritability, frustration, or anger; anxiety; difficulty concentrating; restlessness; decreased heart rate; and increased appetite or weight gain. [encyclopedia.com]

• Seizure

  Spontaneous generalized or partial seizures occurred during withdrawal; the abnormal EEG patterns associated with seizures appeared to originate in various subcortical sites. [ncbi.nlm.nih.gov]

  It is essential to diagnose barbiturate withdrawal quickly, otherwise seizures, delirium, and death may follow. [symptoma.com]

  seizure, chance, syndrome, severity, withdrawal, barbiturate withdrawal, chance of serious barbiturate withdrawal, serious barbiturate withdrawal, phenobarbitol 5: Antipsychotics are not recommended for barbiturate withdrawal (or other CNS depressant [www3.lymba.com]

  Seizures – Seizures can occur at any point during the barbiturate withdrawal timeline. Often, a person will be tapered off of barbiturates instead of stopping abruptly to help prevent seizures and minimize other symptoms. [withdrawal.net]

• Insomnia

  Insomnia. Weakness. Nausea. Vomiting. Anxiety. Tremors or shaking. Rapid heart rate. Seizures. [withdrawal.net]

  The effects of intermediate-acting barbiturates, such as butabarbital sodium, last between 6 and 12 hours, and these are used to treat insomnia. [news-medical.net]

  Barbiturates are typically used to treat anxiety, insomnia, headaches, and seizures. Barbiturates are a type of drug that depresses the central nervous system. The drugs are typically used to treat anxiety, insomnia, headaches, and seizures. [everydayhealth.com]

  Barbiturates became a popular treatment for Insomnia and Anti-Anxiety in the 1960s and 70s. Since then they have fallen out of favor and were replaced by a new class of drug: Benzodiazepines. [sunrisedetox.com]

  Tuinal is a Barbiturate, is used in the short-term treatment of insomnia (to help you fall asleep and stay asleep for a proper rest). It is also used as a sedative to relieve anxiety and induce sleep before surgery. [solutions-recovery.com]

• Tremor

  Symptoms include anxiety, restlessness, insomnia, rhythmic intention tremor, dizziness, seizures, and psychosis. If the syndrome is not recognized and correctly treated, hyperthermia, circulatory failure, and death may ensue. [ncbi.nlm.nih.gov]

  During detox, other medical and psychiatric medications will be prescribed to control symptoms such as high heart rate and blood pressure, anxiety, depression, insomnia, muscle cramping, tremors, etc. [recoveryconnection.com]

  Mid Withdrawal: Progressing to include tremor, fever, diaphoresis, insomnia, anorexia, and diarrhea. [essentialsofcorrectionalnursing.com]

  Stopping cold turkey can result in life threatening seizures, tremors, and muscle cramps. Therefore, it is important to taper off benzodiazepines very slowly with professional help. [blog.palmpartners.com]

• Confusion

  Respiratory depression, hypotension, fatigue, irritability, sedation, confusion and unusual excitement are all possible effects and repercussions of using barbiturates. [avalonmalibu.com]

  The confusion is similar to that seen during alcohol withdrawal, known as delirium tremens (DTs). People who are withdrawing may experience anxiety, disorientation, and visual hallucinations. [medicalnewstoday.com]

  Other clinical features like confusion, delirium, auditory and visual hallucinations, hyperpyrexia, circulatory collapse, and dehydration may occur between 48 to 120 hours after withdrawal. [symptoma.com]

  ROUND 1 Health Effects Benzodiazepines •Diazepam (Valium) •Chlordizapoxide HCI (Librium) •Alprazolam (Xanax) •Triazolam (Halcion) •Estazolam (ProSom) Side effects of benzodiazepine may include: Drowsiness Confusion Dizziness Trembling Impaired coordination [blog.palmpartners.com]

  In larger amounts, speech difficulties, confusion, poor decision making and staggering can result. [rehabthailand.com]

• Slurred Speech

  Larger doses cause slurred speech, staggering, and poor judgement. High doses can cause unconsciousness and death. [gmu.edu]

  Symptoms of barbiturate intoxication and overdose include: Drowsiness or coma Altered consciousness Difficulty thinking Faulty judgement Coordination problems Shallow breathing Slow or slurred speech Sluggishness If you suspect an overdose, contact a [everydayhealth.com]

  If you are concerned that you or a loved one may be dealing with an addiction to barbiturates, be aware of these signs that may occur: Lack of motor coordination Shallow breathing Sleepiness Slurred Speech Sedation Decreased anxiety Inability to make [addictionhope.com]

  As a recreational drug, they produce effects similar to those of alcohol: relaxation and euphoria reduced inhibition slurred speech loss of coordination impaired judgment confusion How quickly barbiturates act and how long their effects last can vary. [medicalnewstoday.com]

History is the most important part of the workup, with the diagnosis being based on clinical findings. It is essential to diagnose barbiturate withdrawal quickly, otherwise seizures, delirium, and death may follow [5]. According to the Diagnostic and Statistical manual of mental disorders (DSM) - 5 [6], the criteria for barbiturate withdrawal are the following:

1. Reduction or cessation of use of sedative
2. Two or more of the following symptoms: autonomic hyperactivity, insomnia, nausea, psychomotor agitation, anxiety, in addition to symptoms already mentioned, developing within hours to days after cessation
3. Symptoms and signs mentioned in criterion 2 result in impairment of social, occupational or other functions
4. The signs and symptoms cannot be due to any other medical condition, mental disorders, intoxication or withdrawal from other substances.

It is important for the physician to elicit a history of the exact barbiturate used/abused, duration of illicit usage or abuse, when it was last ingested, was the drug discontinued suddenly or accidentally, treatment received for withdrawal symptoms, and whether other substances like alcohol were also ingested.

Urine toxicology is performed in all cases and may help to detect other substances consumed along with the barbiturates. Most laboratories are unable to measure blood levels of barbiturates except phenobarbital. Routine laboratory tests like a complete blood cell count (CBC), serum electrolytes, blood urea nitrogen, serum creatinine, and blood glucose levels are obtained to exclude metabolic syndromes which cause symptoms identical to barbiturate withdrawal. Arterial blood gas (ABG) analysis is useful to diagnose metabolic acidosis and respiratory failure while serum lactic acid level helps to evaluate perfusion at the cellular level. A urine pregnancy test should be performed in all women in the childbearing age group.

If you or a loved one needs to find out more about barbiturate addiction treatment as well as treatment for addiction to other substances used along with barbiturates, please call our toll-free helpline for substance addiction treatment and recovery at [projectknow.com]

Ultimately, any delay in getting the right treatment can lead to death. Emergency Treatment Of Barbiturate Withdrawal As a matter of fact, medications form the mainstay of Barbiturate withdrawal treatment. [addictionresource.com]

Learn more about barbiturate withdrawal treatment options and medications. Recovery From Barbiturate Addiction Call Now: 1-888-935-1318 Who Answers? Discuss treatment options with a helpline representative. [withdrawal.net]

Abstract Barbiturate withdrawal seizure susceptibility in rats increased with increasing duration of treatment during a 15-day treatment period in which the animals were given an i.p. dose of sodium barbital every 12 h. [ncbi.nlm.nih.gov]

A person's outcome, also called prognosis, after abusing barbiturates depends on a number of factors. [emedicinehealth.com]

ETIOLOGY Not all patients who take benzodiazepines will experience a discontinuance syndrome when the drug is stopped. Several conditions must be present before the discontinuance syndrome is likely: Duration of treatment. [encyclopedia.com]

Epidemiology of alcohol use and alcoholrelated consequences. In: Alcohol and health. Eighth special report to the U.S. Congress from the Secretary of Health and Human Services. September 1993:1–35. ... 2. Bennett JC, Plum F, eds. [aafp.org]

Search through current and concise descriptions of pathophysiology of diseases and their impact on anesthesia! Gain expertise in understanding the impact of pathophysiology of coexisting diseases on anaesthesia! [books.google.com]

This dual mechanism of action is well matched to the pathophysiology of alcohol withdrawal, making barbiturates theoretically superior to benzodiazepines.. Clinical experience: Barbiturates are more powerful than benzodiazepines. [emcrit.org]

Toggle Nav We go beyond testing to provide you with the information and resources you need to understand and prevent drug abuse. [firstcheckfamily.com]

Barbiturates Image courtesy of the Indiana Prevention Resource Center Barbiturates Image courtesy of the Indiana Prevention Resource Center Behavioral Effects of Barbiturates Barbiturates have several effects on behavior depending on the dose: In low [faculty.washington.edu]

Medical assistance is often recommended for barbiturate withdrawal to reduce the severity of withdrawal symptoms and prevent life-threatening consequences. [withdrawal.net]

The dosage of pentobarbital is gradually reduced until the patient is no longer dependent on it to prevent withdrawal symptoms. [projectknow.com]

To prevent seizures and other problems, withdrawal is accomplished by gradual reduction of the dose. Start withdrawing the patient on diazepam (Valium), 15 to 25 mg four times daily. [mentalhealth.com]

1. Martin PR, Kapur BM, Whiteside EA et al. Intravenous phenobarbital therapy in barbiturate and other hypnosedative withdrawal reactions: a kinetic approach. Clin Pharmacol Ther 1979; 26: 356-364
2. Fitch RH, Tatum AL. The duration of action of the barbituric acid hypnotics as a basis of classification. J Pharmacol Exp Ther 1932; 44: 325-335 25. Ewing JA, Bakewell WE: Diagnosis and management of depressant drug dependence. Am J Psychiatry 1967; 123: 909-917
3. Ewing JA, Bakewell WE: Diagnosis and management of depressant drug dependence. Am J Psychiatry 1967; 123: 909-917
4. Wolff MH (ed): The Barbiturate Withdrawal Syndrome, Munksgaard, Copenhagen, 1959
5. Sarrecchia C1, Sordillo P, Conte G, Rocchi G.Barbiturate withdrawal syndrome: a case associated with the abuse of a headache medication. Ann Ital Med Int. 1998 Oct-Dec; 13(4):237-239
6. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Association. 2013; 550-560.