Toxicología de los barbitúricos

Résumé

Barbiturates have a long history in modern medicine, due to their hypnotic, sedative, and anesthetic anticonvulsant effects. In this study we evaluate whether it is justified their use despite the narrow therapeutic window and the potential toxicity presented. Compared to other drugs with similar indications, barbiturates do not present significantly better therapeutic qualities which could place them as first choice drugs in most cases. Nevertheless there are few situations in which the barbiturates have special interest as neonatal anticonvulsant, antiepileptic or preanesthetic drugs. In this study we reviewed the possible mechanisms of toxicity both in the cellular and organ level, revealing the reasons why these drugs have been relegated to the background in most of their indications. At the cellular level the major cause of toxicity observed is due to the increase of intracellular calcium associated with the opening of the NMDA receptor. On the other hand the adverse effects at an organ level could be considered as an extension of its pharmacological effect. Between both toxic effects, the cellular toxicity levels are much higher than the organ ones, leaving the first one to a secondary position.