Pentobarbital back orders and potential alternatives

AVMA has received multiple reports of short-term back orders of pentobarbital. The Food and Drug Administration Center for Veterinary Medicine (FDA CVM) is aware of the issue and has reached out to sponsors/manufacturers of pentobarbital products to determine the root cause and possible avenues for resolution. Veterinarians can and should report any drug shortage directly to FDA CVM at AnimalDrugShortagesfda [dot] hhs [dot] gov (AnimalDrugShortages[at]fda[dot]hhs[dot]gov).

As a scheduled drug, pentobarbital is regulated by FDA and under the oversight of DEA.

Until this issue is resolved, we know that veterinary practitioners will be looking for alternatives. The following information is summarized from pages 56 through 58 of the AVMA Guidelines for the Euthanasia of Animals: 2020 Edition (AVMA 2020 euthanasia guidelines). Please review the guidelines before deciding the best course of action for your patients and your practice.

Pentobarbital or pentobarbital combination drugs, that are approved by FDA CVM, are a preferred method for euthanasia of dogs, cats, and other small companion animals. Drugs containing pentobarbital that have been approved by FDA CVM and that appear to be currently marketed are summarized in Table 1. During short-term back orders, alternative drugs may need to be considered for euthanasia of these species.

Anesthetic overdose with non-barbiturate injectable drugs may be an acceptable alternative. Options from the AVMA 2020 euthanasia guidelines include ketamine and xylazine given IV, IP, or IM, and propofol given IV. Drugs containing ketamine, xylazine, or propofol that have been approved by FDA CVM and that appear to be currently marketed are listed in Tables 2, 3, and 4.

An overdose of inhaled anesthetic may also be an acceptable alternative under certain conditions. Examples from the AVMA 2020 euthanasia guidelines include an overdose of isoflurane or sevoflurane. Drugs containing isoflurane or sevoflurane approved by FDA CVM and that appear to be currently marketed are summarized in Tables 5 and 6.

Potassium chloride (1 to 2 mmol/kg, 75 to 150 mg/kg, or 1 to 2 mEq K+/kg) administered IV or intracardially may be used adjunctively to euthanize companion animals when they are unconscious (unresponsive to noxious stimuli) or under general anesthesia.

Additional methods in the AVMA 2020 euthanasia guidelines are generally not recommended, but may be used when the conditions described in the guidelines are met.