Barbiturate intoxication and overdose

Barbiturate use is a major addiction problem for many people. Most people who take these medicines for seizure disorders or pain syndromes do not abuse them, but those who do, usually start by using medicine that was prescribed for them or other family members.

Most overdoses of this type of medicine involve a mixture of medicines, usually alcohol and barbiturates, or barbiturates and opioids such as heroin, oxycodone, or fentanyl.

Some users take a combination of all these medicines. Those who use such combinations tend to be:

• New users who do not know these combinations can lead to coma or death
• Experienced users who use them on purpose to alter their consciousness

Symptoms of barbiturate intoxication and overdose include:

• Altered level of consciousness
• Difficulty in thinking
• Drowsiness or coma
• Faulty judgment
• Lack of coordination
• Shallow breathing
• Slow, slurred speech
• Sluggishness
• Staggering, difficulty with balance

Excessive and long-term use of barbiturates, such as phenobarbital, may produce the following chronic symptoms:

• Changes in alertness
• Decreased functioning
• Irritability
• Memory loss

Your health care provider will monitor your vital signs, including temperature, pulse, breathing rate, and blood pressure. Tests that may be done include:

• Blood and urine tests
• Chest x-ray
• CT scan
• Electrocardiogram (ECG)

At the hospital, emergency treatment may include:

• Activated charcoal by mouth or a tube through the nose into the stomach
• Breathing support, including oxygen, tube through the mouth into the lungs, and breathing machine (ventilator)
• Fluids through a vein (IV)
• Medicine to treat symptoms

A medicine called naloxone (Narcan) may be given if an opioid was part of the mix. This medicine often rapidly restores consciousness and breathing in people with an opioid overdose, but its action is short-lived, and may need to be given repeatedly.

There is no direct antidote for barbiturates. An antidote is a medicine that reverses the effects of another medicine or drug.

In select and extreme cases of overdose, dialysis (kidney machine) may be used to help remove the medicine from the blood.

About 1 in 10 people who overdose on barbiturates or a mixture that contains barbiturates will die. They usually die from heart and lung problems.

Complications of an overdose include:

• Coma
• Death
• Head injury and concussion from falls when intoxicated
• Miscarriage in pregnant women or damage to the developing baby in the womb
• Neck and spinal injury and paralysis from falls when intoxicated
• Pneumonia from depressed gag reflex and aspiration (fluid or food down the bronchial tubes into the lungs)
• Severe muscle damage from lying on a hard surface while unconscious, which may lead to permanent kidney injury

Call your local emergency number, such as 911, if someone has taken barbiturates and seems extremely tired or has breathing problems.

Your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1800-222-1222) from anywhere in the United States. This national hotline will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

Intoxication - barbiturates

Aronson JK. Barbiturates. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:819-826.

Overbeek DL, Erickson TB. Sedative hypnotics. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 154.

Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.