Sodium thiopental, also known as thiopental sodium or thiopentone and sold under the brand name Pentothal, is a rapid-onset short-acting barbiturate general anesthetic. It is the thiobarbiturate analog of pentobarbital, and an analog of thiobarbital. Sodium thiopental is a therapeutic alternative on the World Health Organization's List of Essential Medicines.[5] It was the first of three drugs administered during most lethal injections in the United States until the US division of Hospira objected and stopped manufacturing the drug for this purpose in 2011, and the European Union additionally banned the export of the drug for this purpose.[6] Although thiopental abuse carries a dependency risk, its recreational use is rare.[7]
Sodium thiopental is well-known in popular culture, especially under the name "sodium pentothal," as a "truth serum," although its efficacy in this role is questioned.[8][9]
Uses
Anesthesia
Sodium thiopental is an ultra-short-acting barbiturate and has been used commonly in the induction phase of general anesthesia. Its use has been largely replaced with that of propofol, but may retain some popularity as an induction agent for rapid-sequence induction and intubation, such as in obstetrics.[10] Following intravenous injection, the drug rapidly reaches the brain and causes unconsciousness within 30–45 seconds. At one minute, the drug attains a peak concentration of about 60% of the total dose in the brain. Thereafter, the drug distributes to the rest of the body, and in about 5–10 minutes the concentration in the brain is low enough that consciousness returns.
A normal dose of sodium thiopental (usually 4-6 mg/kg) given to a pregnant woman for operative delivery (caesarean section) rapidly makes her unconscious, but the baby in her uterus remains conscious. However, larger or repeated doses can depress the baby's consciousness.[11]
Sodium thiopental is not used to maintain anesthesia in surgical procedures because, in infusion, it displays
Mechanism of action
Sodium thiopental is a member of the barbiturate class of drugs, which are relatively non-selective compounds that bind to an entire superfamily of ligand-gated ion channels, of which the GABAA receptor channel is one of several representatives. This superfamily of ion channels includes the neuronal nicotinic acetylcholine receptor (nAChR), the 5-HT3 receptor, the glycine receptor and others. Surprisingly, while GABAA receptor currents are increased by barbiturates (and other general anesthetics), ligand-gated ion channels that are predominantly permeable for cationic ions are blocked by these compounds. For example, neuronal nAChR are blocked by clinically relevant anesthetic concentrations of both sodium thiopental and pentobarbital.[31] Such findings implicate (non-GABAergic) ligand-gated ion channels, e.g. the neuronal nAChR, in mediating some of the (side) effects of barbiturates.[32] The GABAA receptor is an inhibitory channel that decreases neuronal activity, and barbiturates enhance the inhibitory action of the GABAA receptor.[33]
Controversies
Following a shortage that led a court to delay an execution in California, a company spokesman for Hospira, the sole American manufacturer of the drug, objected to the use of thiopental in lethal injection. "Hospira manufactures this product because it improves or saves lives, and the company markets it solely for use as indicated on the product labeling. The drug is not indicated for capital punishment and Hospira does not support its use in this procedure."[34] On January 21, 2011, the company announced that it would stop production of sodium thiopental from its plant in Italy, because it could not provide Italian authorities with guarantees that exported doses would not be used in executions. According to a company spokesperson, Italy was the only viable place where it could produce the drug, leaving the US without a supplier.[35]
In October 2015 the US Food and Drug Administration (FDA) confiscated an overseas shipment of thiopental destined for the states of Arizona and Texas. The FDA said in a statement, "Courts have concluded that sodium thiopental for the injection in humans is an unapproved drug and may not be imported into the country".[36]
Metabolism
Thiopental rapidly and easily crosses the blood–brain barrier as it is a lipophilic molecule. As with all lipid-soluble anaesthetic drugs, the short duration of action of sodium thiopental is due almost entirely to its redistribution away from central circulation into muscle and fatty tissue, due to its very high lipid–water partition coefficient (approximately 10), leading to sequestration in fatty tissue. Once redistributed, the free fraction in the blood is metabolized in the liver by zero-order kinetics. Sodium thiopental is mainly metabolized to pentobarbital,[37] 5-ethyl-5-(1'-methyl-3'-hydroxybutyl)-2-thiobarbituric acid, and 5-ethyl-5-(1'-methyl-3'-carboxypropyl)-2-thiobarbituric acid.[38]
Dosage
The usual dose range for induction of anesthesia using thiopental is from 3 to 6 mg/kg; however, there are many factors that can alter this. Premedication with sedatives such as benzodiazepines or clonidine will reduce requirements due to drug synergy, as do specific disease states and other patient factors. Among patient factors are: age, sex, and lean body mass.[39] Specific disease conditions that can alter the dose requirements of thiopentone and for that matter any other intravenous anaesthetic are: hypovolemia, burns, azotemia, liver failure, hypoproteinemia, etc.[40]
Contraindications
Thiopental should be used with caution in cases of liver disease, Addison's disease, myxedema, severe heart disease, severe hypotension, a severe breathing disorder, or a family history of porphyria.[41][42]
Co-administration of pentoxifylline and thiopental causes death by acute pulmonary edema in rats. This pulmonary edema was not mediated by cardiac failure or by pulmonary hypertension but was due to increased pulmonary vascular permeability.[43]
History
Sodium thiopental was discovered in the early 1930s by Ernest H. Volwiler and Donalee L. Tabern, working for Abbott Laboratories. It was first used in human beings on March 8, 1934, by Dr. Ralph M. Waters[44] in an investigation of its properties, which were short-term anesthesia and surprisingly little analgesia.[45] Three months later,[46] Dr. John S. Lundy started a clinical trial of thiopental at the Mayo Clinic at the request of Abbott.[47] Abbott continued to make the drug until 2004, when it spun off its hospital-products division as Hospira.
Thiopental is famously associated with a number of anesthetic deaths in victims of the attack on Pearl Harbor. These deaths, relatively soon after the drug's introduction, were said to be due to excessive doses given to shocked trauma patients.
External links
- Vassallo, Susi, M.D. "Thiopental in Lethal Injection" (Archive). Fordham Urban Law Journal. Vol. 35, issue 4. June 18, 2008. pp. 957–968.
References
- Anvisa. RDC Nº 784 - Listas de Substâncias Entorpecentes, Psicotrópicas, Precursoras e Outras sob Controle Especial Diário Oficial da União, 2023-03-31, retrieved 2023-08-16^
- Pentothal DailyMed, retrieved 15 September 2025^
- Pharmacokinetics of thiopental after single and multiple intravenous doses in critical care patients European Journal of Clinical Pharmacology, 1995