Last update: Dec. 8, 2017

Pethidine Hydrochloride

Low Risk for breastfeeding


Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
Read the Comment.

It is excreted in breast milk in very small quantities (Al-Tamimi 2011, Borgatta 1997, Quinn 1986, Peiker 1980) and, in general, no problems have been observed in infants whose mothers were taking it (Al-Tamimi 2011).

After a caesarean section, newborns whose mothers were treated with pethidine to relieve pain showed greater signs of neurological depression during the first three days than those whose mothers were treated with morphine (Reynolds 2011, Wittels 1997 and 1990).

Newborns whose mothers received pethidine, compared to mothers who received fentanyl, morphine or no analgesic drug, had more problems establishing breastfeeding in the first few days, less initial frequency of breastfeeding or greater early stopping of breastfeeding (Fleet 2016 and 2015, Wilson 2010, Yost 2004, Torvaldsen 2006, Ransjö 2001, Spigset 2000, Nissen 1997 and 1995, Lee 1993).

The elimination of the metabolite norpethidine is slower, with a T½ of 20 hours (Lee 1993, Quinn 1986).
Due to these considerations, although the American Academy of Pediatrics considered it to be a medication which was usually compatible with breastfeeding (AAP 2001), later it advised against its use (Sachs 2013) together with other scientific organizations (ABM Protocol # 15 2017 and 2012, ASGE 2012, Gastroenterology, 2012).

Isolated doses for short procedures are unlikely to affect the infant (ABM Protocol # 15 2017 and 2012, WHO / UNICEF 2002).
Avoid repeated doses. Monitor sedation and weak suction, especially in the neonatal period (WHO / UNICEF 2002).

Alternatives

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
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Other names

Pethidine Hydrochloride is also known as


Pethidine Hydrochloride in other languages or writings:

Group

Pethidine Hydrochloride belongs to this group or family:

Tradenames

Main tradenames from several countries containing Pethidine Hydrochloride in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 50 - 60 %
Molecular weight 283 daltons
Protein Binding 60 - 80 %
VD 3,7 - 4,2 l/Kg
pKa 8,6 -
Tmax 0,5 - 0,9 hours
T1/2 3 - 5 hours
M/P ratio 1,1 - 1,6 -
Theoretical Dose 0,01 - 0,17 mg/Kg/d
Relative Dose 0,6 - 3,5 %
Relat.Ped.Dose 0,5 - 1,9 %

References

  1. Hemati Z, Abdollahi M, Broumand S, Delaram M, Namnabati M, Kiani D. Association between Newborns' Breastfeeding Behaviors in the First Two Hours After Birth and Drugs Used For Their Mothers in Labor. Iran J Child Neurol. 2018 Spring;12(2):33-40. Abstract
  2. Fleet JA, Jones M, Belan I. The influence of intrapartum opioid use on breastfeeding experience at 6 weeks post partum: A secondary analysis. Midwifery. 2017 Abstract
  3. Reece-Stremtan Sarah, Campos Matilde, Kokajko Lauren, and The Academy of Breastfeeding Medicine. Breastfeeding Medicine. ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2017. Breastfeed Med. 2017 Nov;12(9):500-506. Full text (link to original source) Full text (in our servers)
  4. Fleet J, Belan I, Jones MJ, Ullah S, Cyna AM. A comparison of fentanyl with pethidine for pain relief during childbirth: a randomised controlled trial. BJOG. 2015 Abstract
  5. Sachs HC; Committee On Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013 Sep;132(3):e796-809. Abstract Full text (link to original source) Full text (in our servers)
  6. ASGE Standard of Practice Committee, Shergill AK, Ben-Menachem T, Chandrasekhara V, Chathadi K, Decker GA, Evans JA, Early DS, Fanelli RD, Fisher DA, Foley KQ, Fukami N, Hwang JH, Jain R, Jue TL, Khan KM, Lightdale J, Pasha SF, Sharaf RN, Dominitz JA, Cash BD. Guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc. 2012 Abstract Full text (link to original source) Full text (in our servers)
  7. American Association for the Study of Liver Diseases; American College of Gastroenterology; American Gastroenterological Association Institute; American Society for Gastrointestinal Endoscopy; Society for Gastroenterology Nurses and Associates, Vargo JJ, DeLegge MH, Feld AD, Gerstenberger PD, Kwo PY, Lightdale JR, Nuccio S, Rex DK, Schiller LR. Multisociety sedation curriculum for gastrointestinal endoscopy. Gastroenterology. 2012 Abstract Full text (link to original source) Full text (in our servers)
  8. Reynolds F. Labour analgesia and the baby: good news is no news. Int J Obstet Anesth. 2011 Abstract
  9. Wilson MJ, MacArthur C, Cooper GM, Bick D, Moore PA, Shennan A; COMET Study Group UK. Epidural analgesia and breastfeeding: a randomised controlled trial of epidural techniques with and without fentanyl and a non-epidural comparison group. Anaesthesia. 2010 Abstract Full text (link to original source) Full text (in our servers)
  10. Torvaldsen S, Roberts CL, Simpson JM, Thompson JF, Ellwood DA. Intrapartum epidural analgesia and breastfeeding: a prospective cohort study. Int Breastfeed J. 2006 Abstract Full text (link to original source) Full text (in our servers)
  11. Yost NP, Bloom SL, Sibley MK, Lo JY, McIntire DD, Leveno KJ. A hospital-sponsored quality improvement study of pain management after cesarean delivery. Am J Obstet Gynecol. 2004 Abstract
  12. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  13. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. Abstract Full text (link to original source) Full text (in our servers)
  14. Ransjö-Arvidson AB, Matthiesen AS, Lilja G, Nissen E, Widström AM, Uvnäs-Moberg K. Maternal analgesia during labor disturbs newborn behavior: effects on breastfeeding, temperature, and crying. Birth. 2001 Abstract
  15. Spigset O, Hägg S. Analgesics and breast-feeding: safety considerations. Paediatr Drugs. 2000 Abstract
  16. Borgatta L, Jenny RW, Gruss L, Ong C, Barad D. Clinical significance of methohexital, meperidine, and diazepam in breast milk. J Clin Pharmacol. 1997 Abstract
  17. Wittels B, Glosten B, Faure EA, Moawad AH, Ismail M, Hibbard J, Senal JA, Cox SM, Blackman SC, Karl L, Thisted RA. Postcesarean analgesia with both epidural morphine and intravenous patient-controlled analgesia: neurobehavioral outcomes among nursing neonates. Anesth Analg. 1997 Abstract
  18. Nissen E, Widström AM, Lilja G, Matthiesen AS, Uvnäs-Moberg K, Jacobsson G, Boréus LO. Effects of routinely given pethidine during labour on infants' developing breastfeeding behaviour. Effects of dose-delivery time interval and various concentrations of pethidine/norpethidine in cord plasma. Acta Paediatr. 1997 Abstract
  19. Nissen E, Lilja G, Matthiesen AS, Ransjö-Arvidsson AB, Uvnäs-Moberg K, Widström AM. Effects of maternal pethidine on infants' developing breast feeding behaviour. Acta Paediatr. 1995 Abstract
  20. Lee JJ, Rubin AP. Breast feeding and anaesthesia. Anaesthesia. 1993 Jul;48(7):616-25. Review. Abstract Full text (link to original source) Full text (in our servers)
  21. Wittels B, Scott DT, Sinatra RS. Exogenous opioids in human breast milk and acute neonatal neurobehavior: a preliminary study. Anesthesiology. 1990 Abstract
  22. Quinn PG, Kuhnert BR, Kaine CJ, Syracuse CD. Measurement of meperidine and normeperidine in human breast milk by selected ion monitoring. Biomed Environ Mass Spectrom. 1986 Abstract
  23. Peiker G, Müller B, Ihn W, Nöschel H. [Excretion of pethidine in mother's milk (author's transl)]. Zentralbl Gynakol. 1980 Abstract

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