What are the brand names and street names for barbiturates (e.g. Nembutal (pentobarbital), Seconal (secobarbital), Luminal (phenobarbital))?

Brand Names and Street Names for Barbiturates

The most commonly encountered barbiturates in clinical practice include pentobarbital (Nembutal), secobarbital (Seconal), phenobarbital (Luminal), butalbital (found in combination products like Fiorinal/Fioricet), and amobarbital (Amytal), with street names typically derived from their color-coded capsules or effects, including "reds/red devils" (secobarbital), "yellows/yellow jackets" (pentobarbital), "blues/blue heavens" (amobarbital), "barbs," "downers," and "goofballs."

Brand Names by Drug Class

Long-Acting Barbiturates

• Phenobarbital (Luminal): This is the primary long-acting barbiturate with an elimination half-life of 80-120 hours and duration of action of 6-12 hours 1, 2
• Phenobarbital is effective for partial, complex partial, and secondarily generalized seizures, though no longer first-line for all seizure types 3

Short- and Intermediate-Acting Barbiturates

• Pentobarbital (Nembutal): A short-acting barbiturate with elimination half-life of 15-48 hours and duration of action of 3-4 hours 1, 2
• Secobarbital (Seconal): An intermediate-acting barbiturate that is no longer licensed for use in the United States, United Kingdom, and most developed countries, and can only be prescribed to patients already taking it for intractable insomnia 2
• Amobarbital (Amytal): Another intermediate-acting barbiturate no longer licensed in most developed countries 2
• Butalbital: An intermediate-acting barbiturate no longer licensed as a standalone agent but remains available in combination products (Fiorinal, Fioricet, Esgic) with acetaminophen and caffeine 4, 2
• Thiopental (Pentothal): Used primarily as an anesthetic agent 2

Street Names and Abuse Terminology

Color-Coded Street Names

• "Reds" or "Red Devils": Secobarbital, referring to the red capsule color
• "Yellows" or "Yellow Jackets": Pentobarbital, referring to the yellow capsule color
• "Blues" or "Blue Heavens": Amobarbital, referring to the blue capsule color

General Street Names

• "Barbs": Generic term for all barbiturates
• "Downers": Referring to their CNS depressant effects 5
• "Goofballs": General slang term for barbiturates
• "Phennies" or "Purple Hearts": Phenobarbital
• "Rainbows" or "Tooies": Tuinal (combination of secobarbital and amobarbital)

Critical Clinical Considerations

Controlled Substance Status

• Butalbital-containing products are classified as Schedule III controlled substances, requiring appropriate DEA documentation and cannot be refilled as easily as non-controlled medications 4
• All barbiturates are subject to control under the Federal Controlled Substances Act 6

Abuse and Overdose Risks

• Barbiturates are commonly abused substances requiring both clinical and forensic analysis 5
• When combined with other CNS depressants (alcohol, opiates, benzodiazepines), overdose is significantly more dangerous due to additive depressant effects on the CNS and respiratory system 1, 4
• The potentially fatal ingested dose for phenobarbital is >5g with serum concentration >80 mg/L, while for pentobarbital it is >3g with serum concentration >50 mg/L 1

Tolerance and Withdrawal

• Long-term users develop tolerance to sedative-hypnotic effects through CYP-mediated auto-induction, but tolerance to lethal toxicity (respiratory failure) does not develop 1
• Long-term users tolerate higher doses but not higher serum concentrations before being at risk of lethal toxicity 1
• Abrupt discontinuation should be avoided; if time allows before surgery, butalbital should be weaned over 2 weeks 4

Common Clinical Pitfalls

• Confusion in barbiturate names is common, especially between pentobarbital and phenobarbital, which can impact test ordering and provider documentation 7
• To minimize risk of dependence, the American Family Physician recommends limiting use to no more than twice weekly 4