Last update Aug. 16, 2022

Pethidine Hydrochloride

Low Risk

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

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).


  • Butorphanol Tartrate ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Fentanyl ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Ibuprofen ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Morphine (Possibly safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.)
  • Paracetamol ( Safe. Compatible. Minimal risk for breastfeeding and infant.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Pethidine Hydrochloride is also known as

Pethidine Hydrochloride in other languages or writings:


Pethidine Hydrochloride belongs to this group or family:


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


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
3 - 5. / Norpet.: 15 - 30 hours
M/P ratio 1.1 - 1.6 -
Theoretical Dose 0.01 - 0.17 mg/Kg/d
Relative Dose 0.6 - 3.5 %
Ped.Relat.Dose 0.5 - 1.9 %


  1. Dejbakht M, Montaseri Z, Saem J, Rezaei M, Akbarzadeh M. Effect of Maternal Pethidine on Breast Feeding Behavior of Infants in Cesarean Section by Spinal Anesthesia: A Randomized Controlled Trial. Arch Iran Med. 2021 Aug 1;24(8):591-598. Abstract
  2. Fan HSL, Wong JYH, Fong DYT, Lok KYW, Tarrant M. Association Between Intrapartum Factors and the Time to Breastfeeding Initiation. Breastfeed Med. 2020 Jun;15(6):394-400. Abstract
  3. Kinugasa M, Miyake M, Tamai H, Tamura M. Safety and efficacy of a combination of pethidine and levallorphan for pain relief during labor: An observational study. J Obstet Gynaecol Res. 2019 Feb;45(2):337-344. Abstract
  4. 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
  5. 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
  6. 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)
  7. 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
  8. Adams J, Frawley J, Steel A, Broom A, Sibbritt D. Use of pharmacological and non-pharmacological labour pain management techniques and their relationship to maternal and infant birth outcomes: examination of a nationally representative sample of 1835 pregnant women. Midwifery. 2015 Apr;31(4):458-63. Abstract
  9. Dalal PG, Bosak J, Berlin C. Safety of the breast-feeding infant after maternal anesthesia. Paediatr Anaesth. 2014 Abstract
  10. 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)
  11. AGA - 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 Jul;143(1):e18-41. Abstract Full text (link to original source) Full text (in our servers)
  12. 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 Jul;76(1):18-24. Abstract Full text (link to original source) Full text (in our servers)
  13. Reynolds F. Labour analgesia and the baby: good news is no news. Int J Obstet Anesth. 2011 Abstract
  14. 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)
  15. 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)
  16. 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
  17. 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 Abstract Full text (link to original source) Full text (in our servers)
  18. 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
  19. 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)
  20. Spigset O, Hägg S. Analgesics and breast-feeding: safety considerations. Paediatr Drugs. 2000 Abstract
  21. 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
  22. 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
  23. Borgatta L, Jenny RW, Gruss L, Ong C, Barad D. Clinical significance of methohexital, meperidine, and diazepam in breast milk. J Clin Pharmacol. 1997 Mar;37(3):186-92. Abstract
  24. 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
  25. Rajan L. The impact of obstetric procedures and analgesia/anaesthesia during labour and delivery on breast feeding. Midwifery. 1994 Jun;10(2):87-103. Abstract
  26. 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)
  27. Wittels B, Scott DT, Sinatra RS. Exogenous opioids in human breast milk and acute neonatal neurobehavior: a preliminary study. Anesthesiology. 1990 Abstract
  28. Onur E, Erçal T, Karslioğlu I. Prolactin and cortisol levels during spontaneous and oxytocin induced labour and the effect of meperidine. Arch Gynecol Obstet. 1989;244(4):227-32. Abstract
  29. 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
  30. 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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