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Indications:

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.

Contraindications:

History of hypersensitivity to pethidine. Coma. Respiratory depression or obstructive airways disease. Use in patients receiving monoamine oxidase inhibitors or within two weeks following their withdrawal.

Adverse reactions:

The 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. The most frequently observed adverse effects include lightheadedness, dizziness, sedation, nausea, vomiting and sweating. Other adverse effects include; Nervous System: Euphoria, dysphoria, weakness, headache, agitation, tremor, uncoordinated muscle movements, convulsions, hallucinations, visual disturbances. Increased risk of delirium in elderly patients. Gastrointestinal: Dry mouth, constipation, biliary tract spasm. Cardiovascular: Flushing of the face, tachycardia, bradycardia, palpitation, hypotension, syncope. Genitourinary: Urinary retention. Allergic: Pruritus, urticaria, other skin rashes, wheal and flare over the vein with intravenous injection. Other: Pain at the injection site and local tissue irritation.

Interactions:

The central depressant effects of pethidine may be potentiated by the concurrent use of other central nervous system depressants including anxiolytics, hypnotics, antidepressants, other analgesics, alcohol and general anaesthetics; respiratory depression, hypotension and profound sedation or coma may result. Severe hypotension may occur when pethidine is administered to patients whose ability to maintain blood pressure has been compromised by a depleted blood volume or by the administration of drugs such as phenothiazine. Cimetidine inhibits metabolism of pethidine and therefore increases plasma concentration. Very severe reactions including coma, respiratory depression, cyanosis and hypotension have occurred in patients administered monoamine inhibitors (MAOIs). Pethidine should not be administered to patients taking MAOIs or to those who have taken MAOIs within 14 days (see Special Warnings and Precautions for Use). The interaction of pethidine with MAOIs may result in Serotonin syndrome. Use of pethidine in prolonged increasing dosage or concomitantly with anticholinergics may result in neurotoxicity in patients with renal failure, cancer or sickle cell anaemia.

Warnings:

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 reduced respiratory function. 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, biliary tract disorders, hypothyroidism, adrenocortical insufficiency, shock, prostatic hypertrophy and supraventricular tachycardia. Caution is also required in patients with acute alcoholism, raised intracranial pressure or convulsive disorders. Repeated administration of pethidine may produce physical and psychological dependence of the morphine type, with the development of withdrawal symptoms on abrupt cessation of therapy or on administration of a narcotic antagonist. Repeated administration may also induce tolerance, with a tendency to increase the dose in order to obtain the desired effect.

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