Pethidine Hydrochloride

Meperidine or pethidine is a potent opioid agonist with analgesic and sedative properties that is used to control severe pain. Oral, intramuscular or intravenous administration.

It is excreted in breast milk in very small quantities (Al-Tamimi 2011, Borgatta 1997, Wittels 1990, Quinn 1986, Peiker 1980) and, in general, no problems have been observed in infants whose mothers were taking it (Al-Tamimi 2011).

Plasma levels in these infants were very low, around 1% of maternal levels. ^{(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 y 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 ^{(Dejbakht 2021, Fan 2020, Hemati 2018, Fleet 2017 & 2015, Adams 2015, Wilson 2010, Yost 2004, Torvaldsen 2006, Ransjö 2001, Spigset 2000, Nissen 1997 & 1995, Rajan 1994, Lee 1993)}. Other studies have found no breastfeeding problems with the use of pethidine. ^{(Kinugasa 2019)}

Meperidine can increase serum prolactin levels. ^(Onur1989)

The elimination of the metabolite norpethidine is slower, with a T½ of 20 hours, and greater (63 hours) in the neonatal period. ^{(Dalal 2014, 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. ^{(Reece 2017, ASGE 2012, AGA 2012)}

Isolated doses for short procedures are unlikely to affect the infant ^{(Reece 2017, WHO / UNICEF 2002)}. Avoid repeated doses. Monitor sedation and weak suction, especially in the neonatal period. ^{(WHO / UNICEF 2002).}