Trimiperidine - instructions for use, dose, side effects, contraindications

Clinical and pharmacological group: & nbsp

Opioid narcotic analgesics

Included in the formulation

Promedol

solution for injections

MOSCOW ENDOCRINE FACTORY, FSUE Russia

Promedol

pills inwards

STATE FACTORY OF MEDICAL PREPARATIONS, FSUE Russia

Promedol

solution for injections

STATE FACTORY OF MEDICAL PREPARATIONS, FSUE Russia

Included in the list (Order of the Government of the Russian Federation No. 2782-r of 30.12.2014):

VED

ONLS

АТХ:

N.01.A.H Opioid analgesics

Pharmacodynamics:

Agonist opioidnyh μ-, δ- and φ-receptors (activation of μ-receptors is 2 times stronger than δ and κ): suppression of interneuronal transmission of pain impulses in the afferent ways of the central nervous system, reducing the emotional assessment of pain and reaction to it.

Pharmacokinetics:

Absorption is good. Relationship with plasma proteins 40%. Penetrates through the placenta and the blood-brain barrier. Biotransformation in the liver. The half-life is2,4-4 h, increases with chronic renal failure. Elimination by the kidneys (5% unchanged).

Indications:

Pain syndrome of moderate to severe intensity (unstable angina, myocardial infarction, exfoliating aneurysm of the aorta, thrombosis of the renal artery, thromboembolism of the arteries of the extremities or pulmonary artery, acute pericarditis, air embolism, lung infarction, acute pleurisy, spontaneous pneumothorax, peptic ulcer and 12-finger guts, perforation of the esophagus,chronic pancreatitis, paranephritis, acute dysuria, Paraphimosis, priapism, acute prostatitis, acute glaucoma attack, causalgia, acute neuritis, sciatica, acute vesicles, thalamic syndrome, burns, cancer, trauma, disc protrusion; foreign bodies of the bladder, rectum, urethra).

In combination with atropine and antispasmodics for pain caused by spasm of smooth muscles of internal organs (liver, kidney, intestinal colic).

Acute left ventricular failure, pulmonary edema, cardiogenic shock.

Preoperative, operating and postoperative periods.

Childbirth (anesthesia and stimulation).

Neuroleptanalgesia (in combination with neuroleptics).

ICD-10

VII.H40-H42 Glaucoma

IX.I20-I25.I20.0 Unstable angina

IX.I20-I25.I21 Acute myocardial infarction

IX.I26-I28.I26 Pulmonary embolism

IX.I30-I52.I30 Acute pericarditis

X.J80-J84.J81 Pulmonary edema

XI.K20-K31.K25 Stomach ulcer

XI.K20-K31.K26 Duodenal ulcer

XI.K80-K87.K80 Gallstone disease [cholelithiasis]

XI.K80-K87.K86.1 Other chronic pancreatitis

XIII.M50-M54.M54.1 Radiculopathy

XIII.M50-M54.M54.3 Sciatica

XIII.M50-M54.M54.4 Lumbago with sciatica

XIII.M70-M79.M79.2 Neuralgia and neuritis, unspecified

XIV.N20-N23.N23 Renal colic, unspecified

XIV.N40-N51.N41 Inflammatory diseases of the prostate

XVIII.R10-R19.R10.4 Other and unspecified abdominal pain

XVIII.R50-R69.R52.0 Acute pain

XVIII.R50-R69.R52.2 Another constant pain

XVIII.R50-R69.R57.0 Cardiogenic shock

XIX.T08-T14 Injuries to the unspecified part of the trunk, limb or body region

XIX.T20-T32 Thermal and chemical burns

XXI.Z40-Z54.Z51.4 Preparatory procedures for subsequent treatment, not elsewhere classified

Contraindications:

Hypersensitivity, depression of the respiratory center; with epidural and spinal anesthesia: a clotting disorder (including anticoagulant therapy), infection (the risk of infection in the central nervous system); diarrhea against pseudomembranous colitis caused by cephalosporins, lincosamides, penicillins, toxic dyspepsia (delayed elimination of toxins and related exacerbation and prolongation of diarrhea); simultaneous treatment with MAO inhibitors (including during the 21st day after their application).

Carefully:

Pain in abdomen of unclear etiology, surgical interventions on the gastrointestinal tract, urinary system; bronchial asthma, chronic obstructive pulmonary disease, convulsions, arrhythmias, arterial hypotension, chronic heart failure,respiratory insufficiency, hepatic and / or renal failure, myxedema, hypothyroidism, adrenal insufficiency, CNS depression, intracranial hypertension, head trauma, prostatic hyperplasia, suicidal tendencies, emotional lability, drug dependence (including in history), severe inflammatory bowel disease , urethral stricture, alcoholism, seriously ill, weakened patients, cachexia, pregnancy, breast-feeding, elderly and children.

Pregnancy and lactation:

Adequate and well-controlled studies in humans and animals have not been conducted. Use with caution in pregnancy and lactation.

Category of recommendations FDA is not defined.

Dosing and Administration:

Subcutaneously, intramuscularly or intravenously (only subcutaneously and intramuscularly for the drug in syringe tubes).

Adults: from 0.01 g to 0.04 g (from 1 ml of a 1% solution to 2 ml of a 2% solution). During anesthesia with fractional doses, the drug is administered intravenously to 0.003-0.01 g.

Children from two years: 0.003-0.01 g, depending on age.

For premedication, under the skin or intramuscularly, 0.02-0.03 g, together with atropine (0.0005 g) for 30-45 minutes before the operation, is administered before anesthesia.

Anesthesia of childbirth: subcutaneously or intramuscularly at a dose of 0.02-0.04 g when the opening of the throat is 3-4 cm and with a satisfactory fetal condition. The last dose of the drug is administered for 30-60 minutes before the delivery in order to avoid a drug depression of the fetus and the newborn.

Higher doses for adults: single dose - 0.04 g, daily - 0.16 g.

Side effects:

From the side gastrointestinal tract: constipation, nausea, vomiting, dry mouth, anorexia, spasm of bile ducts; with inflammatory bowel diseases - paralytic intestinal obstruction and toxic megacolon; jaundice.

From the side nervous system and sense organs: dizziness, headache, blurred vision, diplopia, tremor, involuntary muscle contraction, convulsions, weakness, drowsiness, confusion, disorientation, euphoria, nightmarish or unusual dreams, hallucinations, depression, paradoxical agitation, restlessness, rigidity of muscles (especially respiratory) , ringing in the ears, slowing the speed of psychomotor reactions.

From the side respiratory system: depression of the respiratory center.

From the side of cardio-vascular system: decrease or increase of arterial pressure, arrhythmia.

From the side urinary system: decreased urine output, urine retention.

Allergic reactions: bronchospasm, laryngospasm, angioedema, skin rash, skin itch, face swelling.

Local reactions: hyperemia, edema, "burning" at the injection site.

Other: increased sweating, addiction, drug dependence.

Overdose:

Symptoms acute and chronic overdose: cold sticky sweat, confusion, dizziness, drowsiness, decreased blood pressure, nervousness, fatigue, miosis, bradycardia, severe weakness, slow labored breathing, hypothermia, anxiety, dry mouth, delirious psychosis, intracranial hypertension (up to disorders of cerebral circulation), hallucinations, muscle rigidity, convulsions, in severe cases - loss of consciousness, respiratory arrest, coma.

Treatment: gastric lavage, recovery of respiration and maintenance of cardiac activity and blood pressure; intravenous injection of a specific antagonist opioid analgesics - naloxone in a single dose of 0.2-0.4 mg with repeated administration 2-3 minutes before the total dose of 10 mg; the initial dose of naloxone for children is 0.01 mg / kg.

Interaction:

Alcohol, drugs that depress the central nervous system - potentiation of oppressive effects on the central nervous system, including the respiratory center.

Anticholinergics, antidiarrheals - the risk of severe constipation and acute retention of urine.

Antihypertensive drugs, especially ganglion blockers and diuretics - potentiation of the hypotensive effect.

Buprenorphine - a decrease in the therapeutic effect of other μ-receptor agonists, including a reduction in respiratory depression, the emergence of withdrawal syndrome in dependent individuals.

Other drugs that cause drug dependence are an increased risk of developing drug dependence.

Zidovudine - morphine competitively inhibits biotransformation in the liver of zidovudine, combined use increases the toxicity of each drug.

Metoclopramide - decreased prokinetic activity of metoclopramide.

Miorelaxants - potentiation of respiratory depression.

Naltrexone, naloxone, nalorfin - antidotes of narcotic analgesics, eliminate all their pharmacological effects, including cause withdrawal syndrome in patients with drug dependence to them.

Narcotic analgesics - mutual potentiation of effects.

Phenotiazine neuroleptics - some increase, and some reduce the effect of morphine.

Special instructions:

Synthetic narcotic analgesic, piperidine derivative. 2-4 times weaker than morphine.

The drug is necessary Store in a dark place out of the reach of children at a temperature not exceeding 15 ° C.

List II "List of narcotic drugs, psychotropic substances and their precursors".

Instructions

Trimiperidine (Trimeperidinum)