SURITAL

Clinical safety rating: caution

Comprehensive clinical and safety monograph for SURITAL (SURITAL).

How it works

SURITAL (thiamylal) is an ultra-short-acting barbiturate that enhances GABA-A receptor activity, increasing chloride ion conductance and neuronal hyperpolarization, resulting in rapid induction of anesthesia.

What the body does with it

Metabolism	Primarily hepatic metabolism via microsomal enzyme oxidation (CYP2B6, CYP3A4) to inactive metabolites; minor renal excretion.
Excretion	Primarily renal excretion of metabolites; <1% unchanged. Minor biliary/fecal elimination.
Half-life	Terminal elimination half-life 2-8 hours (mean 4.5 h) in adults; prolonged in hepatic impairment.
Protein binding	~70% bound to albumin.
Volume of Distribution	1.5-2.5 L/kg; indicates extensive tissue distribution.
Bioavailability	IM: ~90%.
Onset of Action	IV: 30-60 seconds; IM: 2-5 minutes.
Duration of Action	IV: 5-15 minutes (single dose); IM: 10-30 minutes. Longer with continuous infusion.

Classification & Brands

Dosing & administration

Induction: 3-5 mg/kg IV bolus over 10-15 seconds. Maintenance: 0.5-1.5 mg/kg IV as needed for anesthesia. Also used as 0.2-0.4% solution for IV infusion at 0.5-2 mg/min.

Dosage form	INJECTABLE
Renal impairment	No specific GFR-based adjustments; metabolized primarily in liver. Caution in severe renal impairment due to potential accumulation of inactive metabolites.
Liver impairment	Child-Pugh A: No adjustment. Child-Pugh B: Reduce dose by 50% and titrate to effect. Child-Pugh C: Contraindicated or use with extreme caution with reduced doses (e.g., 25-50% of normal).
Pediatric use	Induction: 3-6 mg/kg IV. Maintenance: 1-2 mg/kg IV as needed. Use with caution; not recommended for neonates.
Geriatric use	Reduce dose by 30-50% due to decreased clearance and increased sensitivity. Administer slowly and titrate to effect.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for SURITAL (SURITAL).

Breastfeeding	Excretion into breast milk is unknown; M/P ratio not established. Due to high lipid solubility, potential for significant transfer. Consider risks of neonatal CNS depression. Use with caution; monitor infant for sedation, poor feeding, and respiratory depression. Alternative agents preferred.
Teratogenic Risk	Pregnancy Category D (positive evidence of human fetal risk). First trimester: Risk of congenital anomalies (limb defects, CNS malformations) based on animal studies and limited human data. Second/third trimester: Increased risk of preterm labor, fetal bradycardia, neonatal respiratory depression, and withdrawal syndrome. Avoid use during pregnancy unless clearly needed.

Warnings & precautions

■ FDA Black Box Warning

WARNING: RESPIRATORY DEPRESSION AND CARDIAC ARREST. SURITAL may cause severe respiratory depression or apnea, especially with rapid administration. Resuscitative equipment and personnel trained in airway management must be immediately available. Avoid intra-arterial injection due to risk of arteriospasm, thrombosis, and gangrene.

Side Effect Profile

Serious Effects

Absolute Contraindications

Absolute: Known hypersensitivity to barbiturates, acute intermittent porphyria, severe respiratory insufficiency, status asthmaticus, and conditions where general anesthesia is contraindicated.

Clinical Precautions

Precautions

Monitor respiratory and cardiac function continuously; use with caution in patients with respiratory compromise, hypotension, shock, or hepatic/renal impairment; may cause laryngospasm, bronchospasm, or hypotension; avoid extravasation; use with caution in porphyria.

Clinical Tips & Counseling

Drug interactions

Loading safety data…

SURITAL

Clinical safety rating: caution

Comprehensive clinical and safety monograph for SURITAL (SURITAL).

How it works

What the body does with it

Metabolism	Primarily hepatic metabolism via microsomal enzyme oxidation (CYP2B6, CYP3A4) to inactive metabolites; minor renal excretion.
Excretion	Primarily renal excretion of metabolites; <1% unchanged. Minor biliary/fecal elimination.
Half-life	Terminal elimination half-life 2-8 hours (mean 4.5 h) in adults; prolonged in hepatic impairment.
Protein binding	~70% bound to albumin.
Volume of Distribution	1.5-2.5 L/kg; indicates extensive tissue distribution.
Bioavailability	IM: ~90%.
Onset of Action	IV: 30-60 seconds; IM: 2-5 minutes.
Duration of Action	IV: 5-15 minutes (single dose); IM: 10-30 minutes. Longer with continuous infusion.

Classification & Brands

Dosing & administration

Induction: 3-5 mg/kg IV bolus over 10-15 seconds. Maintenance: 0.5-1.5 mg/kg IV as needed for anesthesia. Also used as 0.2-0.4% solution for IV infusion at 0.5-2 mg/min.

Dosage form	INJECTABLE
Renal impairment	No specific GFR-based adjustments; metabolized primarily in liver. Caution in severe renal impairment due to potential accumulation of inactive metabolites.
Liver impairment	Child-Pugh A: No adjustment. Child-Pugh B: Reduce dose by 50% and titrate to effect. Child-Pugh C: Contraindicated or use with extreme caution with reduced doses (e.g., 25-50% of normal).
Pediatric use	Induction: 3-6 mg/kg IV. Maintenance: 1-2 mg/kg IV as needed. Use with caution; not recommended for neonates.
Geriatric use	Reduce dose by 30-50% due to decreased clearance and increased sensitivity. Administer slowly and titrate to effect.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for SURITAL (SURITAL).

Breastfeeding	Excretion into breast milk is unknown; M/P ratio not established. Due to high lipid solubility, potential for significant transfer. Consider risks of neonatal CNS depression. Use with caution; monitor infant for sedation, poor feeding, and respiratory depression. Alternative agents preferred.
Teratogenic Risk	Pregnancy Category D (positive evidence of human fetal risk). First trimester: Risk of congenital anomalies (limb defects, CNS malformations) based on animal studies and limited human data. Second/third trimester: Increased risk of preterm labor, fetal bradycardia, neonatal respiratory depression, and withdrawal syndrome. Avoid use during pregnancy unless clearly needed.

Warnings & precautions

■ FDA Black Box Warning

Side Effect Profile

Serious Effects

Absolute Contraindications

Absolute: Known hypersensitivity to barbiturates, acute intermittent porphyria, severe respiratory insufficiency, status asthmaticus, and conditions where general anesthesia is contraindicated.