• Moderate to severe pain:
    • Adult: IV 25-50mg  every 4 hours PRN
    • Adult: IM/SC 25-100mg every 4 hours PRN
    • Child: IV/IM/SC 0.5-2mg/kg. Max 10mg/kg/day
    • >85 years: IM/SC 20-30mg every 3-4 hours for < 24 hours 
  • Obstetric analgesia:
    • SC/IM 50-100mg every 1-3 hours. Max 300mg/day
  • Premedication:
    • IM 50-100mg 1 hour prior to operation 
  • Enhancement of analgesia:
    • IV 25-50mg 
  • Post-operative pain:
    • SC/IM 25-100mg every 2-3 hours

Injection: 50mg/ml, 100mg/2ml

  • Consider prescribing naloxone if risk of opioid overdose or accidental ingestion
  • Inject into large muscle mass when repeated injection is needed, IM is preferred to SC
  • IV should be injected very slowly at a rate of 10mg/ml.
  • Naloxone, administration of oxygen and control of respiration should be available during and immediately after administration.
  • Norpethidine, a metabolite and precursor of pethidine, can accumulate in the body and cause convulsions after high doses of pethidine administration.
  • Naloxone can’t be used in norpethidine toxicity as it antagonizes sedative effect but not excitatory effect of pethidine.
  • Dose should be titrated according to response, respiratory rate and sedation score.
  • Oral route is not recommended for treatment of acute or chronic pain

Synthetic opioid.

It binds to various opioid receptors inhibiting ascending  pain pathways and producing analgesia, respiratory depression and sedation.

  • Vomiting
  • Anxiety
  • Lightheadedness
  • Diaphoresis
  • Tremors
  • Seizures
  • Respiratory depression
  • Hypotension
  • Tachycardia
  • Hypersensitivity to excipients
  • Renal failure
  • Use within 14 days after MAOI use
  • Acute/severe bronchial asthma
  • Severe respiratory depression
  • Paralytic ileus
  • GI obstruction
  • Coma/impaired consciousness
  • Phaeochromocytoma
  • Head injuries
  • Circulatory shock
  • MAOI
  • Anticonvulsants
  • Antipsychotics
  • Ritonavir
  • Cimetidine
  • CNS depressants

Pethidine (Fresenius, Martindale)

                                   Drug Status

Availability Prescription only
Pregnancy Category C
Breastfeeding Contraindicated unless single dose
Schedule Controlled