Barbiturates List: Common Types and Their Uses
A list of common barbiturates, what they are and were used for, how they differ, and the serious risks of dependence, overdose, and withdrawal.
Clinically reviewed by Dr. Ponlawat Pitsuwan, Physician and Addiction Medicine Specialist, Phuket Island Rehab.
Barbiturates are a class of sedative drugs that act on the central nervous system to slow brain activity, once widely prescribed as sleeping pills, sedatives, and anti-anxiety medicines, and still used today in more limited roles such as controlling seizures, in anaesthesia, and for certain other conditions. A list of common barbiturates includes phenobarbital (used for seizures), secobarbital (Seconal), pentobarbital (Nembutal), amobarbital (Amytal), butalbital (found in combination headache medicines such as Fioricet and Fiorinal), butabarbital (Butisol), and thiopental (a short-acting anaesthetic). Barbiturates are often grouped by how long they act, from ultra-short-acting to long-acting. Although they were once very common, barbiturates have largely been replaced for many uses by safer medicines such as benzodiazepines, because barbiturates are highly addictive and especially dangerous in overdose: the difference between an effective dose and a fatal one is small, and overdose can stop breathing. They also cause a dangerous physical dependence, and stopping them suddenly can cause life-threatening withdrawal, including seizures. If you or someone you know is dependent on barbiturates, medical help is essential, and addiction is treatable with the right support.
What are barbiturates?
Barbiturates are a class of sedative-hypnotic drugs that act on the central nervous system to slow down brain activity, producing effects that range from mild relaxation and drowsiness to deep sedation and anaesthesia, depending on the drug and the dose. They were first developed in the early twentieth century and, for much of the last century, were among the most widely prescribed medicines in the world, used as sleeping pills, sedatives, anti-anxiety medicines, and for other purposes. Over time, however, it became clear that barbiturates are highly addictive and particularly dangerous, especially in overdose, and for most of these uses they have been largely replaced by safer medications, particularly benzodiazepines. Today, barbiturates are used in more limited roles, such as controlling certain types of seizures, in anaesthesia, and for a few other specific medical situations.
This article provides a list of common barbiturates, explains what they are and were used for, how they differ from one another, and, importantly, sets out the serious risks they carry, including dependence, overdose, and dangerous withdrawal. The central message is that while barbiturates have genuine medical uses and were once extremely common, they are potent and hazardous drugs with a high potential for addiction and a narrow margin of safety, meaning the difference between a helpful dose and a deadly one can be small. Understanding the different barbiturates and their dangers is useful both for recognising these medicines and for appreciating why they must be treated with great care. It is also important to know that barbiturate dependence is a serious medical matter requiring supervised treatment, and that with the right help, addiction to barbiturates is treatable.
A list of common barbiturates
There are many barbiturates, and they are often grouped by how quickly they act and how long their effects last, from ultra-short-acting (used mainly in anaesthesia) through short- and intermediate-acting (once used as sleeping pills and sedatives) to long-acting (used for seizures). The following are among the most well-known barbiturates. Phenobarbital is a long-acting barbiturate still used today, mainly to control certain seizures and epilepsy, and sometimes in the management of withdrawal from other sedatives. Secobarbital (brand name Seconal) is a short-acting barbiturate that was widely used as a sleeping pill. Pentobarbital (Nembutal) is a short-acting barbiturate used historically for sedation and sleep and now in limited medical and veterinary contexts. Amobarbital (Amytal) is an intermediate-acting barbiturate once used as a sedative and sleeping aid.
Other barbiturates include butalbital, an intermediate-acting barbiturate that is still found today in combination medicines used for tension headaches and migraines, combined with painkillers such as acetaminophen or aspirin and caffeine (brand names include Fioricet and Fiorinal); butabarbital (Butisol), used as a sedative; and thiopental (thiopentone), an ultra-short-acting barbiturate used as an anaesthetic to induce sleep for surgery. Historically there were many others used as sleeping pills and sedatives. It is worth noting that although some barbiturates, such as phenobarbital and butalbital-containing medicines, are still prescribed, many of the barbiturates once used as sleeping pills and sedatives are now rarely prescribed for those purposes, having been replaced by safer alternatives. Whatever their specific use, all barbiturates share the same basic action of depressing the central nervous system, and all carry the class’s characteristic risks of dependence, dangerous overdose, and hazardous withdrawal, which are described below.
| Barbiturate | Brand / use |
|---|---|
| Phenobarbital | Long-acting; seizures/epilepsy, withdrawal management |
| Secobarbital | Seconal; short-acting sleeping pill (historical) |
| Pentobarbital | Nembutal; sedation, sleep, limited use now |
| Amobarbital | Amytal; intermediate-acting sedative (historical) |
| Butalbital | Fioricet/Fiorinal; combination headache medicines |
| Butabarbital / Thiopental | Butisol sedative / anaesthetic |
Why barbiturates are dangerous
Barbiturates are dangerous for several related reasons, which is why they have largely been replaced by safer drugs. The first and most serious is their narrow margin of safety, or narrow therapeutic index: the difference between a dose that produces the desired effect and a dose that is dangerous or fatal is small. This means that taking somewhat too much, whether by accident, to enhance the effect, or because tolerance has developed, can lead to a life-threatening overdose. In overdose, barbiturates dangerously depress the central nervous system and breathing, and can cause loss of consciousness, coma, and death from respiratory failure. This danger is greatly increased when barbiturates are combined with other depressants, especially alcohol or opioids, which multiply the effect on breathing. Barbiturate overdose was historically a common cause of both accidental and deliberate death, and there is no simple antidote, so treatment relies on supportive intensive care.
The second major danger is addiction and dependence. Barbiturates are highly addictive: with regular use, tolerance develops (so more is needed for the same effect), and physical dependence develops, meaning the body adapts to the drug. Dangerously, tolerance to the desired effects develops faster than tolerance to the dose that can stop breathing, so as a person takes more to get the same effect, they move closer to a fatal dose, which makes dependence especially perilous. Psychological addiction, with compulsive use and cravings, can also develop. The third danger is withdrawal: because dependence is so profound, stopping barbiturates suddenly after regular use can cause a severe and genuinely life-threatening withdrawal syndrome, with symptoms including anxiety, tremor, insomnia, agitation, hallucinations, high temperature, and seizures, which can be fatal. This is why barbiturates must never be stopped abruptly after regular use, but reduced gradually under medical supervision. Together, the narrow safety margin, the high addictiveness, the deadly overdose risk, and the dangerous withdrawal make barbiturates among the more hazardous drugs, and explain why they are used far more cautiously today.
Dependence, withdrawal, and getting help
Because barbiturate dependence and withdrawal are so serious, anyone who is dependent on barbiturates should seek medical help, and should never try to stop suddenly on their own, because of the risk of life-threatening withdrawal seizures. Treatment for barbiturate dependence begins with a medically supervised withdrawal (detox), in which the drug is reduced gradually, sometimes by switching to a longer-acting barbiturate such as phenobarbital and tapering it slowly, or using other supportive measures, all under close medical monitoring to keep the person safe and manage withdrawal symptoms. This medical supervision is essential and, for significant dependence, is often best carried out in a setting where the person can be closely monitored. Getting through withdrawal safely is the first stage; lasting recovery involves more.
Beyond safe withdrawal, treatment for barbiturate addiction includes counselling and behavioural therapies, which help a person understand and change the patterns driving their use, manage cravings, and address any underlying issues, along with support for recovery and treatment of any co-occurring mental health conditions such as anxiety, depression, or insomnia, which may have led to the barbiturate use in the first place and which need to be addressed in healthier ways. Depending on the severity, treatment may be provided through a structured program, sometimes residential, particularly given the medical risks involved. The key messages are that barbiturates are a class of potent sedative drugs, once very common but now used more cautiously because they are highly addictive and especially dangerous in overdose and withdrawal, that the common barbiturates include phenobarbital, secobarbital, pentobarbital, amobarbital, and butalbital-containing medicines, and that if you or someone you know is dependent on barbiturates, medical help is essential and addiction is treatable with the right, safely managed support.
Summary
Barbiturates are a class of sedative drugs that act on the central nervous system to slow brain activity, once widely prescribed as sleeping pills, sedatives, and anti-anxiety medicines, and still used today in more limited roles such as controlling seizures, in anaesthesia, and for certain other conditions. A list of common barbiturates includes phenobarbital (used for seizures), secobarbital (Seconal), pentobarbital (Nembutal), amobarbital (Amytal), butalbital (found in combination headache medicines such as Fioricet and Fiorinal), butabarbital (Butisol), and thiopental (a short-acting anaesthetic). Barbiturates are often grouped by how long they act, from ultra-short-acting to long-acting. Although they were once very common, barbiturates have largely been replaced for many uses by safer medicines such as benzodiazepines, because barbiturates are highly addictive and especially dangerous in overdose: the difference between an effective dose and a fatal one is small, and overdose can stop breathing. They also cause a dangerous physical dependence, and stopping them suddenly can cause life-threatening withdrawal, including seizures. If you or someone you know is dependent on barbiturates, medical help is essential, and addiction is treatable with the right support.
As Dr. Ponlawat Pitsuwan, addiction medicine specialist at Phuket Island Rehab, puts it, “Barbiturates were the sleeping pills and sedatives of an earlier era, and there is a reason we largely moved away from them. The margin is frighteningly small; the dose that helps you sleep is not far from the dose that stops your breathing, and because tolerance to the effect grows faster than tolerance to that danger, chasing the effect walks you toward a fatal dose. And the withdrawal can kill, with seizures, which is why I never let anyone come off them abruptly. Phenobarbital and the butalbital headache tablets still have their place, but these are serious drugs. If someone is dependent, this is one where medical detox is not optional, and the good news is that, done safely, people recover.”
Frequently asked questions
What are the most common barbiturates?
The most common and well-known barbiturates include phenobarbital, a long-acting barbiturate still used today mainly to control seizures and epilepsy and sometimes in withdrawal management; secobarbital (brand name Seconal), a short-acting barbiturate once widely used as a sleeping pill; pentobarbital (Nembutal), a short-acting barbiturate used historically for sedation and sleep; amobarbital (Amytal), an intermediate-acting sedative and sleeping aid; and butalbital, an intermediate-acting barbiturate still found today in combination medicines for tension headaches and migraines (with painkillers and caffeine, under brand names such as Fioricet and Fiorinal). Others include butabarbital (Butisol), a sedative, and thiopental, an ultra-short-acting anaesthetic. Barbiturates are often grouped by how long they act, from ultra-short-acting (used in anaesthesia) to long-acting (used for seizures). While some, like phenobarbital and butalbital-containing medicines, are still prescribed, many barbiturates once used as sleeping pills and sedatives are now rarely used for those purposes, having been replaced by safer medicines. All barbiturates share the same basic sedative action and the same serious risks of dependence, overdose, and dangerous withdrawal.
What were barbiturates used for?
Barbiturates were once among the most widely prescribed medicines in the world, used for a range of purposes. Their main uses were as sleeping pills for insomnia, as sedatives to calm anxiety and agitation, and as anti-anxiety medicines. They were also used in anaesthesia (short-acting barbiturates such as thiopental to induce sleep for surgery), to control seizures and epilepsy (particularly long-acting phenobarbital), and for some other specific conditions. Over the course of the twentieth century, however, it became clear that barbiturates were highly addictive and especially dangerous in overdose, with a narrow margin between effective and fatal doses, and for most of these uses they were gradually replaced by safer alternatives, particularly benzodiazepines for anxiety and sleep. Today, barbiturates are used in more limited roles: phenobarbital for certain seizures and sometimes in withdrawal management, butalbital in combination medicines for some headaches, and certain barbiturates in anaesthesia and a few other specific situations. So while barbiturates once had broad use, that use has narrowed considerably because of their dangers.
Why are barbiturates so dangerous?
Barbiturates are dangerous for several reasons. The most serious is their narrow margin of safety: the difference between a dose that produces the desired effect and one that is dangerous or fatal is small, so taking somewhat too much can cause a life-threatening overdose. In overdose, barbiturates dangerously depress breathing and can cause coma and death from respiratory failure, a danger greatly increased when combined with alcohol or opioids, and there is no simple antidote. They are also highly addictive, causing tolerance and profound physical dependence; dangerously, tolerance to the desired effect develops faster than tolerance to the dose that can stop breathing, so taking more to get the effect moves a person closer to a fatal dose. Finally, withdrawal is dangerous: stopping barbiturates suddenly after regular use can cause a severe, potentially fatal withdrawal syndrome including seizures. Together, the narrow safety margin, the deadly overdose risk, the high addictiveness, and the dangerous withdrawal make barbiturates among the more hazardous drugs, which is why they have largely been replaced by safer medicines and are now used far more cautiously.
Are barbiturates still used today?
Yes, but in more limited roles than in the past. Although barbiturates were once extremely common as sleeping pills, sedatives, and anti-anxiety medicines, they have largely been replaced for those uses by safer medicines, particularly benzodiazepines, because of their dangers. Today, some barbiturates remain in use for specific purposes. Phenobarbital, a long-acting barbiturate, is still used to control certain seizures and epilepsy and is sometimes used in the management of withdrawal from alcohol or other sedatives. Butalbital is still found in combination medicines used for tension headaches and migraines (with painkillers and caffeine). Certain barbiturates are used in anaesthesia, and a few in other specific medical or veterinary contexts. So while the broad use of barbiturates has declined dramatically because of their addictiveness and danger, they have not disappeared entirely and continue to have certain valid, more specialised uses. Where they are used, it is with awareness of their risks and, for medicines like phenobarbital and butalbital-containing products, appropriate caution about dependence and, in the case of butalbital, overuse.
What happens if you stop taking barbiturates suddenly?
Stopping barbiturates suddenly after regular use is dangerous and can be life-threatening, because barbiturates cause a profound physical dependence. Abrupt withdrawal can trigger a severe withdrawal syndrome, with symptoms that may include anxiety, restlessness, tremor, insomnia, nausea, agitation, hallucinations, a high temperature, and, critically, seizures, which can be fatal. In severe cases, barbiturate withdrawal can resemble the dangerous withdrawal seen with alcohol and can include delirium. Because of this, barbiturates must never be stopped abruptly after regular use; instead, they should be reduced gradually (tapered) under medical supervision, sometimes by switching to a longer-acting barbiturate such as phenobarbital and tapering it slowly, with close monitoring to keep the person safe and manage symptoms. Anyone who is dependent on barbiturates and wishes to stop should seek medical help rather than stopping on their own, and for significant dependence this is often best done where the person can be closely monitored. With safe, medically supervised withdrawal followed by therapy and support, recovery from barbiturate dependence is achievable, but the withdrawal stage in particular must be handled medically because of its dangers.
How is barbiturate addiction treated?
Barbiturate addiction is treated in stages, beginning with a medically supervised withdrawal (detox), which is essential because stopping barbiturates suddenly can cause life-threatening withdrawal, including seizures. During detox, the drug is reduced gradually, sometimes by switching to a longer-acting barbiturate such as phenobarbital and tapering it slowly, or with other supportive measures, all under close medical monitoring. For significant dependence, this is often best done in a setting where the person can be closely observed. Once safe withdrawal is achieved, lasting recovery involves counselling and behavioural therapies, which help a person understand and change the patterns driving their use, manage cravings, and address underlying issues, along with support for recovery. Treatment also addresses any co-occurring mental health conditions, such as anxiety, depression, or insomnia, which may have led to the barbiturate use and which need to be managed in healthier ways. Depending on severity, treatment may be provided through a structured program, sometimes residential, particularly given the medical risks involved. With this combination of safe medical withdrawal, therapy, and support, people do recover from barbiturate addiction. If you or someone you know is dependent on barbiturates, seeking medical help is essential and recovery is possible.
Sources
National Library of Medicine (MedlinePlus). Barbiturate Intoxication and Overdose. https://medlineplus.gov/ency/article/000951.htm
Drug Enforcement Administration (DEA). Barbiturates Drug Fact Sheet. https://www.dea.gov/factsheets/barbiturates
National Institute on Drug Abuse (NIDA). Prescription CNS Depressants. https://nida.nih.gov/research-topics/prescription-drugs
National Library of Medicine (MedlinePlus). Phenobarbital. https://medlineplus.gov/druginfo/meds/a682007.html
Substance Abuse and Mental Health Services Administration (SAMHSA). Substance Use. https://www.samhsa.gov/
U.S. Food and Drug Administration (FDA). Butalbital Combination Products. https://www.fda.gov/drugs
Barbiturates list — key entities and related terms
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