Who can administer
Administration RESTRICTED - see Appendix 1
Important information
- Stored as a controlled drug in GUH
- For use by anaesthetists only
- Extravasation can cause local tissue necrosis and severe pain - use central line or large peripheral line (ref 1).
- Resite cannula at first signs of inflammation (ref 1)
- Accidental intra-arterial injection causes severe arterial spasm and an intense burning pain around the injection site (ref 1)
- For Y-site compatibility see below
Available preparations
Important:
- Different brands have differing expiry times for infusion (after reconstitution)
- Check which brand is being used to determine expiry time, and discuss with pharmacist
| Brand |
Product |
Expiry time for infusion after preparation |
| Inresa |
Thiopental 500mg vial |
Not licensed for administration by intravenous infusion
Clinical decision required - see comment on Metavision (ICU CIS)
|
| Panpharma |
Thiopental 500mg vial |
9 hours (ref 1) |
| Advanz |
Thiopental 500mg vial |
6 hours (ref 1) |
Reconstitution
If for Bolus intermittent injection
- Water for injection
- 20ml per 500mg vial (produces a 25mg/ml (2.5%) solution)
- Inject the required volume of diluent into the vial so that the solvent vigorously swirls up the powder (to avoid lumping)
If for Continuous intravenous infusion
- Water for injection or Sodium chloride 0.9% (ref 1)
- Inject the required volume of diluent into the vial so that the solvent vigorously swirls up the powder (to avoid lumping)
Infusion fluids
Sodium chloride 0.9%
Methods of intravenous administration
Bolus intravenous injection
- Administer over 20 seconds (some brands specify a slightly different rate (ref 1))
- Some manufacturers suggest a test dose of 25 to 75mg (over 10 to 15 seconds) can precede the main administration (ref 1,2).
- Monitor for at least 60 seconds to assess tolerance or unusual sensitivity to the drug(ref 1)
Continuous intravenous infusion
- Prepare a 2mg or 4mg per mL solution using infusion fluid above
- Fluid restricted patients: May use a concentration of up to 50mg/mL(ref 1)
- Some manufacturers suggest a test dose of 25 to 75mg (over 10 to 15 seconds) can precede the main administration (ref 1,2).
- Monitor for at least 60 seconds to assess tolerance or unusual sensitivity to the drug(ref 1)
Dose in adults
Use in convulsive states (ref 3)
- Give 75 to 125mg as soon as possible after the convulsion begins
- Further doses may be required
Use in ventilated neurological patients with raised intracranial pressure (ref 2,3)
- Intermittent bolus doses of 1.5 to 3mg/kg may be given to reduce elevations of intracranial pressure
Barbiturate coma for refractory status epilepticus or for refractory high intracranial pressure (unlicensed)(ref 2,4)
- Loading dose by bolus intravenous injection
- Maintenance dose by continuous intravenous infusion
- Titrate infusion rate to burst suppression pattern on electroencephalography (EEG)
- Higher doses have been tried for refractory status epilepticus (up to 7mg/kg/hour) (ref 2)
Use in anaesthesia
- A test dose of 25 to 75mg can precede the main administration (ref 1,2). Monitor for at least 60 seconds to assess tolerance or unusual sensitivity to the drug(ref 1)
- Give 100 to 150 mg over 10 to 15 seconds(ref 2,3)
- A repeat dose of 100 to 150mg may be given after 30 to 60 seconds(ref 2,3)
- Maximum dose 500mg(ref 3)
Monitoring
- Severe or refractory hypokalaemia during the infusion has been reported, severe rebound hyperkalaemia may occur after administration has stopped (ref 1)
- Monitor injection site (can cause extravasation)
Storage
- Controlled drug
- Do not store above 250C
References
Thiopental Inresa SPC 06/09/2014
1: Injectable medicines guide, downloaded from Medusa 26/03/2026
2: Martindale, downloaded from Medicinescomplete 26/03/2026
3: BNF, downloaded from Medicinescomplete 26/03/2026
4: Critical Illness, downloaded from MedicinesComplete 26/03/2026
Search synonym thiopentone
Therapeutic classification
Barbiturate
(used as a general anaesthetic agent - hence Appendix 1)
