Pethidine hydrochloride

Pethidine hydrochloride

[1 ampoule 84 cents]

ADMINISTRATION ROUTES:

  • IV, IM, PO

ALTERNATIVE NAMES:

  • aka meperidine

ICU INDICATIONS:

  1. analgesia
  2. shivering

PRESENTATION AND ADMINISTRATION:

  • IV:
    Pethidine 100mg in 2ml 50mg in 1ml ampoules.
    Dilute solution to 10mg/ml with Water for Injection.
    Inject slowly over 3-5 minutes (do not exceed 50mg per dose when administering via this route)
    Compatible with the following IV fluids:
    0.9% sodium chloride, Hartmanns, 5% or 10% dextrose, Glucose and sodium chloride
    Store at room temperature
  • IM:
    Preferred route for repeated or large doses (as it is less irritating than IV)
  • PO:
    Tablets:
    Pethidine 50mg tablets (white), Pethidine 100mg tablets (white)

DOSAGE:

  • IV:
    Usually 25-50mg IV 4 hourly (rare for more than a single dose to be used in the ICU setting)

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose in renal impairment [GFR (ml/min)]
    <10: avoid
    10-20: avoid
    >20-50: use small doses; increase dosing interval to 6 hours.
  • Dose in renal replacement therapy
    CAPD: avoid
    HD: use small doses; increase dosing interval to 6 hours.
    CVVHDF: dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • IM:
    0.5-2mg/kg 4 hourly
  • IV:
    0.5-1mg/kg 4 hourly

CLINICAL PHARMACOLOGY:

  • Pethidine is a narcotic analgesic with multiple actions qualitatively similar to those of morphine; the most prominent of these involve the central nervous system and organs composed of smooth muscle. The principal actions of therapeutic value are analgesia and sedation.

CONTRAINDICATIONS:

  1. hypersensitivity to pethidine

WARNINGS

  • Impaired Respiration:
    Respiratory depression is the chief hazard of all opioids. Respiratory depression occurs most frequently in the elderly and debilitated patients as well as in those suffering from conditions accompanied by hypoxia or hypercapnia when even moderate therapeutic doses may dangerously decrease pulmonary ventilation.
    Pethidine should be used with extreme caution in patients with chronic obstructive pulmonary disease or cor pulmonale, and in patients having a substantially decreased respiratory reserve, hypoxia, hypercapnia, or preexisting respiratory depression. In such patients, even usual therapeutic doses of morphine may decrease respiratory drive while simultaneously increasing airway resistance to the point of apnoea.
  • Hypotensive Effect:
    Morphine sulphate controlled-release tablets, like all opioid analgesics, may cause severe hypotension in an individual whose ability to maintain his blood pressure has already been compromised by a depleted blood volume, or a concurrent administration of drugs that lower blood pressure.
  • Anaphylaxis:
    Although extremely rare, cases of anaphylaxis have been reported.

PRECAUTIONS

  • General:
    Supraventricular Tachycardias
    — Pethidine should be used with caution in patients with atrial flutter and other supraventricular tachycardias because of a possible vagolytic action which may produce a significant increase in the ventricular response rate.
    Convulsions
    — Pethidine may aggravate pre-existing convulsions in patients with convulsive disorders. If dosage is escalated substantially above recommended levels because of tolerance development, convulsions may occur in individuals without a history of convulsive disorders.
  • Laboratory Tests: No tests in addition to routine ICU tests are indicated
  • Drug/Laboratory Test Interactions: None noted

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • The concomitant use of other central nervous system depressants including sedatives or hypnotics, general anaesthetics, phenothiazines, tranquilizers, and alcohol may produce additive depressant effects. Respiratory depression, hypotension, and profound sedation or coma may occur.

ADVERSE REACTIONS

  • Central Nervous System:
    Euphoria, sedation, dysphoria, weakness, headache, agitation, tremor, uncoordinated muscle movements, severe convulsions, transient hallucinations and disorientation, visual disturbances.
  • Respiratory:
    respiratory depression
  • Gastrointestinal:
    Nausea and vomiting, dry mouth, biliary tract spasm, constipation, ileus, intestinal obstruction.
  • Cardiovascular:
    Flushing of the face, chills, tachycardia, bradycardia, palpitation, faintness, syncope, hypotension, hypertension.
  • Genitourinary:
    Urine retention or hesitance, reduced libido and/or potency.
  • Dermatologic:
    Pruritus, urticaria, other skin rashes, edema, diaphoresis.

Critical Care Drug Manual

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