Clinical medicine profile
Pethidine
Opioid analgesic
- Route
- ORAL / IV / IM / SC / TD / RECTAL
- Schedule
- POM
- ATC
- Not assigned
- PPB status
- registered
Safety essentials
The information most likely to change a prescribing or dispensing decision.
Contraindications
- Acute respiratory depression, severe asthma/COPD without monitoring, paralytic ileus, acute alcoholism, raised intracranial pressure in unstable settings, MAOI interactions for some agents.
Precautions
- Severe bronchial asthma, cyanosis respiratory depression, severely limited respirato
- ry reserve.
- Narcotic analgesics [as it has some narcotic antagonistic effect], sedation, dizziness and may increase chances of occurrence of serotonin syndrome.
- It should not be used within 2 hours of expected delivery as it can cause respira- tory depression to the newborn.
Dosing matrix
Population and organ-function guidance, shown together for faster comparison.
Adults: SC or IM:25-100mg. IV: 25 -50mg. The dose should not be repeated before the lapse of 4hrs. Children: The usual single dose is 0.5 to 2mg/kg
See label paediatric section if present; otherwise use paediatric formulary — do not extrapolate adult doses.
Prefer fentanyl/methadone expert use over morphine in advanced CKD; reduce doses.
- CrCl 0–120: Confirm renal dosing in product SmPC / primary label.
Reduce dose/frequency; avoid long-acting in decompensated disease.
Use, effects & interactions
Indications
- Relief of moderate to severe pain
- pre-operative or pre-anaesthetic medication
- supplement to surgical anesthesia.
- Clinical selection for Pethidine should follow culture results where relevant, Kenya STG/EML recommendations, and the current product SmPC.
- Class context: Opioid analgesic.
- Confirm site-specific dose, duration and monitoring before prescribing.
Adverse effects
- Nausea, constipation, sedation, pruritus, urinary retention.
- Serious: respiratory depression, coma, death in overdose, serotonin syndrome (tramadol), seizures (tramadol/pethidine).
Drug interactions
Open multi-drug checker ↗- Norpethidine is a metabo- lite of and a precursor to pethidine with little opioid activity.
- It acts as a stimulant and causes convulsions.
- As a metabolite it tends to accumu- late in the body after administration of high doses of pethidine.
- Naloxone is never used in norpethi- dine toxicity as it antagonizes sedative but not excitatory effect of pethidine.
Mechanism & disposition
Opioids agonise CNS mu (primarily), kappa and delta receptors, inhibiting ascending pain pathways and altering pain perception/response.
Read complete mechanism
Opioids agonise CNS mu (primarily), kappa and delta receptors, inhibiting ascending pain pathways and altering pain perception/response. Also cause respiratory depression, miosis, cough suppression and reduced GI motility.
Minutes (IV) to hour (oral)
Hours (agent-dependent)
ORAL / IV / IM / SC / TD / RECTAL
(CYP2D6 critical for codeine/tramadol activation — ultrarapid metabolisers risk toxicity; poor metabolisers lack efficacy). Renal
of active metabolites (morphine-6-glucuronide accumulates in CKD).
Pregnancy, lactation & diet
Use only if necessary; neonatal withdrawal with chronic maternal use. Prefer specialist obstetric advice.
Codeine generally avoided (CYP2D6). Short-term morphine sometimes used with monitoring — check guidance.
Brands & loaded prices
| Brand | Manufacturer | Pack | Observed price |
|---|---|---|---|
| PETHEROL Solution for Injection | Tasa Pharma Limited | Solution For Injection | Unavailable |
| Pethidine | Martindale | tabs 10's | Unavailable |
Sources & review state
Decision support only. Confirm patient-specific decisions against the current product SmPC, Kenya STG/EML, and professional judgement.