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PETHIDINE HYDROCHLORIDE is a brand name for Meperidine (also known as Pethidine). The medicine, its uses, side effects and dosage are the same regardless of brand.
Used for: Pethidine hydrochloride may be used as an analgesic for the relief of moderate to severe pain including: obstetric analgesia; pre-operative medication and analgesia during anaesthesia; post-operative analgesia.
Verbatim from this product's MHRA label. Tap a section to expand.
4). Adults The following single doses may be used and should not usually be repeated more frequently than four hourly; Subcutaneous or intramuscular injection: 25 - 100mg. Intravenous injection: 25 - 50mg. Elderly or debilitated patients The initial dose should not exceed 25mg, because of the particular sensitivity among elderly or debilitated patients to the central depressant effects of pethidine.
5 to 2mg/kg body weight by intramuscular injection. If necessary, this dose may be repeated, allowing a minimum of four hours between doses. Use of a small graduated syringe is recommended for the accurate administration of dosages in children.
In the absence of graduated syringes, the solution should be diluted with Water for Injections before measuring the dose. Method of administration Pethidine Injection may be administered by subcutaneous, intramuscular or slow intravenous injection.
The information below lists reported adverse reactions, ranked using the following frequency classification: Very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1,000 to <1/100); rare (≥1/10,000 to <1/1,000); very rare (<1/10,000), not known (cannot be estimated from the available data).
4), confusion, mood altered, mild euphoria, hallucinations, dysphoria, agitation, anxiety, nervousness. Increased risk of delirium in elderly patients. Nervous system disorders Not known Drowsiness, dizziness, tremor, convulsions, headache, CNS excitation, syncope, light-headedness, sedation Eye disorders Not known Visual disturbances, dry eye, miosis Ear and labyrinth disorders Not known Vertigo Cardiac disorders Not known Tachycardia, bradycardia, palpitations Vascular disorders Not known Flushing of face, orthostatic hypotension, hypotension1, hypertension, vasodilatation Respiratory, thoracic and mediastinal disorders Not known Respiratory depression1 Gastrointestinal disorders Not known Nausea, vomiting, dry mouth, constipation Hepatobiliary disorders Not known Biliary or Ureteric spasm Skin and subcutaneous tissue Not known Sweating, rash, urticaria, disorders pruritis Musculoskeletal and connective tissue disorders Not known Uncoordinated muscle movements, muscle twitching Renal and urinary disorders Not known Difficulty in micturition, renal colic, urinary retention Reproductive system and breast disorders Not known Sexual dysfunction General disorders and administration site conditions Uncommon Not known Drug withdrawal syndrome Hypothermia, weakness, injection site reactions including pain, induration and irritation, wheal and flare over the vein with intravenous injection Investigations Not known Corneal reflex decreased 1The most serious adverse effects of pethidine are respiratory depression and hypotension.
Rapid intravenous administration of pethidine increases the incidence of these effects and may result in serious respiratory depression and hypotension with tachycardia. Reporting of suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important.
Pethidine is controlled under the Misuse of Drugs Act 1971 (Schedule 2). If the intravenous route is being used, pethidine should be given slowly in order to reduce the risk of adverse reactions. Extreme care is required when administering pethidine to patients with asthma, severe cor pulmonale or reduced respiratory function.
Pethidine should be used with caution or in reduced doses in patients with myasthenia gravis. Pethidine should only be used with caution and in reduced dosage in neonates and premature infants, elderly and debilitated patients and in patients with head injuries, severe hepatic or renal impairment.
Renal impairment may result in accumulation of the potentially toxic metabolite norpethidine, particularly with repeat dosing. All of these patient groups may experience increased or prolonged effects of the product. Pethidine should be used with caution in patients with hypothyroidism, adrenocortical insufficiency, shock, and supraventricular tachycardia.
Although less spasmogenic than morphine, pethidine may precipitate spasm of the ureter or Sphincter of Oddi. Subsequently it should be used with caution in patients with prostatic hypertrophy and biliary tract disorders including those with pain secondary to gallbladder pathology.
Caution is also required in patients with acute alcoholism, raised intracranial pressure, or history of convulsive disorders, existing hypotension as it may reduce the blood pressure further, myasthenia gravis. In addition it should be avoided in patients with obstructive or inflammatory bowel disorders due to its effects on the gastrointestinal tract where it may precipitate toxic megacolon.
Drug dependence, tolerance and potential for abuse For all patients, prolonged use of this product may lead to drug dependence (addiction), even at therapeutic doses. , major depression). Additional support and monitoring may be necessary when prescribing for patients at risk of opioid misuse.
1. • Use of pethidine should be avoided in patients with diabetic acidosis where there is danger of coma. • In comatose patients • It also contra-indicated in conditions associated with raised intracranial pressure and in head injury (opioid analgesics interfere with pupillary responses vital for neurological assessment).
• Use of pethidine in patients with Phaeochromocytoma may result in hypertensive crisis. • Acute respiratory depression, severe obstructive airways disease or acute asthma and when there is risk of paralytic ileus or obstructive airways disease.
• Use in patients receiving monoamine oxidase inhibitors (including moclobemide, and the monoamine B inhibitors selegiline and rasagiline) or within two weeks following their withdrawal. • It should not be administered to patients with severe renal impairment or severe hepatic impairment.
• Should be avoided in patients with acute alcoholism, delirium tremens or in those with convulsive states such as status epilepticus. • Pethidine should not be administered to patients receiving ritonavir and isoniazid. • Use of pethidine should be avoided in patients with supraventricular tachycardia.
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
Other brands of Meperidine in United Kingdom.
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A comprehensive patient history should be taken to document concomitant medications, including over-the-counter medicines and medicines obtained on-line, and past and present medical and psychiatric conditions. Patients may find that treatment is less effective with chronic use and express a need to increase the dose to obtain the same level of pain control as initially experienced.
Patients may also supplement their treatment with additional pain relievers. These could be signs that the patient is developing tolerance. The risks of developing tolerance should be explained to the patient. Overuse or misuse may result in overdose and/or death.
It is important that patients only use medicines that are prescribed for them at the dose they have been prescribed and do not give this medicine to anyone else. Patients should be closely monitored for signs of misuse, abuse, or addiction.
The clinical need for analgesic treatment should be reviewed regularly. Drug withdrawal syndrome Prior to starting treatment with any opioids, a discussion should be held with patients to put in place a withdrawal strategy for ending treatment with Pethidine.
Drug withdrawal syndrome may occur upon abrupt cessation of therapy or dose reduction. When a patient no longer requires therapy, it is advisable to taper the dose gradually to minimise symptoms of withdrawal. Tapering from a high dose may take weeks to months.
The opioid drug withdrawal syndrome is characterised by some or all of the following: restlessness, lacrimation, rhinorrhoea, yawning, perspiration, chills, myalgia, mydriasis and palpitations. Other symptoms may also develop including irritability, agitation, anxiety, hyperkinesia, tremor, weakness, insomnia, anorexia, abdominal cramps, nausea, vomiting, diarrhoea, increased blood pressure, increased respiratory rate or heart rate.
If women take this drug during pregnancy, there is a risk that their newborn infants will experience neonatal withdrawal syndrome. Hyperalgesia Hyperalgesia may be diagnosed if the patient on long-term opioid therapy presents with increased pain.
This might be qualitatively and anatomically distinct from pain related to disease progression or to breakthrough pain resulting from development of opioid tolerance. Pain associated with hyperalgesia tends to be more diffuse than the pre-existing pain and less defined in quality.
Symptoms of hyperalgesia may resolve with a reduction of opioid dose. Risk from concomitant use of sedative medicines such as benzodiazepines or related drugs: Concomitant use of Pethidine and sedative medicines such as benzodiazepines or related drugs may result in sedation, respiratory depression, coma and death.
Because of these risks, concomitant prescribing with these sedative medicines should be reserved for patients for whom alternative treatment options are not possible. If a decision is made to prescribe Pethidine concomitantly with sedative medicines, the lowest effective dose should be used, and the duration of treatment should be as short as possible.
The patients should be followed closely for signs and symptoms of respiratory depression and sedation. 5). Paediatric population Pethidine has a slower elimination rate and a larger inter-subject variability in neonates and young infants compared to older children and adults, which may lead to dose related reactions such as respiratory depression.
If pethidine use is contemplated in neonates or young infants (up to 12 months), any potential benefits of the drug need to be weighed against the relative risk to the patient. This medicine contains less than 1 mmol sodium (23 mg) per dose, that is to say essentially ‘sodium-free’.