Medication

Promedol

Structure

1 tablet includes 25 mg trimeperidine.

1 ml of injection includes 10 mg or 20 mg trimeperidine.

Release form

The drug Promedol is available in the form of tablets of 10 or 20 pieces per pack, as well as in the form of a 1% or 2% injection solution in ampoules of 5, 10, 100, 150, 200, 250 or 500 pieces per pack.

Pharmachologic effect

Anesthetic, antishock, antispasmodic, uterotonizing, sleeping pills.

Pharmacodynamics and pharmacokinetics

The drug Promedol belongs to the pharmacological group narcotic (opioid) analgesics, with the main analgesic effect. The active substance of Promedol according to the classification of INN - trimeperidineagonistic effect on opioid receptors. Activates endogenous pain medication (antinociceptive) the system, thereby violating, at different levels CNStransportation pain impulses between neurons. Trimeperidinealso influences higher departments brainmodifying emotional coloring pain syndrome.

The pharmacological effects of promedol are similar to those Morfinaand are expressed by increasing pain threshold with symptoms of pain of various origins, inhibition conditioned reflexesas well as mild sleeping pills. Suppression respiratory center, when using Promedol, is manifested to a lesser extent compared with Morphine. The drug less often leads to symptoms such as nauseaand vomitingstrengthens somewhat contractile function and myometrium tonehas moderate antispasmodic efficacy in relation to uretersand bronchus as well as spasmogenic, yielding to the action Morphine, towards intestinesand biliary tract.

The development of the analgesic effect of Promedol, with its parenteral administration, is observed after 10-20 minutes, rapidly increases and reaches its maximum value after 40 minutes. High analgesic effects last for 2-4 hours, when epidural anesthesia - more than 8 hours.

Oral administration provides an analgesic effect of the drug, which is 1.5-2 times less than when administered parenterally.

With any delivery method trimeperidineinto the body, its absorption is quite fast. When taken orally, TCmax is observed after 60-120 minutes. When administered intravenously, the contents trimeperidinein plasma decreases rapidly and after 2 hours only its trace concentrations are detected.

With plasma proteins trimeperidinebinds to 40%. Main metabolismtakes place in liverthrough the process of hydrolysis with the release normomeridineand meperidic acid and further conjugation. T1 / 2 takes from 2.4 to 4 hours, with kidney failure increases slightly.

Excreted the kidneysin small quantities, including unchanged 5%.

Indications for use

Stopping pain syndrome medium and strong intensity with:

  • pain after surgical intervention;
  • pain oncologicalpatients
  • myocardial infarction;
  • unstable angina;
  • flakingaortic aneurysm;
  • renal artery thrombosis;
  • sharp pericarditis;
  • thromboembolismpulmonary and limb arteries;
  • aerial embolism;
  • spit pleurisy;
  • heart attack lung;
  • spontaneous pneumothorax;
  • perforation of the esophagus;
  • peptic ulcer;
  • chronic pancreatitis;
  • paranephritis;
  • acute dysuria;
  • renal and hepatic colic;
  • paraphimosis;
  • acute attack glaucoma;
  • priapism;
  • sharp prostate;
  • lumbosacral radiculitis;
  • causalgia;
  • sharp vesiculitis;
  • thalamic syndrome;
  • sharp neuritis;
  • injuries and burns;
  • protrusionsintervertebral disc;
  • foreign bodies in the urethra, rectum, bladder.

Promedol is prescribed in obstetric practice with the aim of labor pain relief and as a lung stimulantpatrimonial activity.

AT surgical practice the drug is indicated for premedicationand composed general anesthesiaas an analgesic component (e.g., conducting neuroleptanalgesia in conjunction with antipsychotics).

Pulmonary edemaacute left ventricular failure and cardiogenic shockare also among the indications for the use of promedol.

Contraindications

Absolute contraindications to taking Promedol are:

  • hypersensitivity patient to trimeperidine;
  • age up to 2 years;
  • painful conditions in which there is respiratory depression;
  • concurrent therapy with MAO inhibitors, as well as the time up to 21 days after their cancellation.

There are also a number of relative contraindications in which the use of Promedol is possible only with extreme caution, these are:

  • respiratory failure;
  • kidney failure and / or liver;
  • chronic heart failure;
  • adrenal insufficiency;
  • traumatic brain injury;
  • CNS depression;
  • intracranial hypertension;
  • hypothyroidism;
  • myxedema;
  • BPH;
  • urethral stricture;
  • surgical procedures on the urinary system or gastrointestinal tract;
  • bronchial asthma;
  • cramps;
  • obstructive pulmonary diseasechronic course;
  • arterial hypotension;
  • arrhythmia;
  • emotional lability;
  • suicidal tendencies;
  • cachexia;
  • alcoholism;
  • elderly age;
  • debilitated patients;
  • bowel disease inflammatory in nature;
  • drug addiction (including history).

Side effects

CNS:

  • blurring of visual perception;
  • dizziness;
  • diplopia;
  • headache;
  • tremor;
  • cramps;
  • involuntary muscle contractions;
  • drowsiness;
  • weakness;
  • disorientation;
  • confusion;
  • euphoria;
  • hallucinations;
  • unusual or nightmare dreams;
  • depression;
  • anxiety;
  • paradoxical agitation;
  • muscle stiffness (especially respiratory);
  • retardation of psychomotor reactions;
  • tinnitus.

Gastrointestinal organs:

  • constipation;
  • dry mouth
  • nausea;
  • anorexia;
  • vomiting;
  • spasm of the biliary tract;
  • toxic megacolonparalytic intestinal obstruction, jaundice(with intestinal diseases of an inflammatory nature).

Respiratory system:

  • respiratory depression.

The cardiovascular system:

  • arrhythmia;
  • blood pressure change (one way or another).

Urinary system:

  • urinary retention;
  • lower urine output.

Allergic manifestations:

  • laryngospasm;
  • bronchospasm;
  • angioedema;
  • swelling of the face;
  • rashand itchingskin integument.

Local reactions:

  • sensation burningat the injection site;
  • edema;
  • hyperemia.

Others:

  • increased sweating;
  • development drug dependence, addictive.

Promedol, instructions for use

Instructions for use of Promedol involves its delivery to the patient through intramuscular (i / m), subcutaneous (s / c) and, in emergency situations, intravenous (iv) injections in the form of a solution, and internal (oral) administration in the form of tablets.

For stopping pain syndrome tablets are recommended for oral administration to adult patients in doses from 25 mg to 50 mg. The maximum daily dose of Promedol in tablets is 50 mg.

For adults, IM and SC are usually prescribed from 10 mg to 40 mg of Promedol (from 1 ampoule of 1% solution to 2 ampoules of 2% solution).

During anesthesiarecommend intravenous administration in divided doses, depending on the situation, 3-10 mg.

At pain syndrometriggered by smooth muscle spasms (intestinal, renal, hepatic colic), appoint Promedol in combination with antispasmodic and atropine-like drugs, under close monitoring of the patient's condition.

With the aim of premedication, and 30-40 minutes before surgery, injected in / m or s / c at 20-30 mg in combination with 0.5 mg BUTthe path.

Promedol at birth appoint for pain reliefand labor stimulation. Injections are carried out intramuscularly or s / c at doses of 20-40 mg, with a positive assessment of the condition of the fetus and the opening of the cervix by 3-4 cm. Promedol promotes muscle relaxation of the cervix, thereby accelerating the process of its disclosure. The last injection should be made 30-60 minutes before the intended delivery, in order to avoid negative consequences during childbirth fetal respiration suppression.

The maximum dose of parenteral administration for adult patients is 40 mg, and the maximum daily dose is 160 mg.

Pediatric, over 2 years old, the dose of Promedol is from 0.1 to 0.5 mg / kg, s / c, in / m and rarely in / in the introduction. Repeated injections, in order to stop the pain, can be carried out after 4-6 hours.

During general anesthesia, as its component, Promedol is administered iv in 0.5-2.0 mg / kg / hour. The maximum dose throughout the duration of the operationsshould be no more than 2 mg / kg / hour.

Infusion is recommended to be administered at 10-50 mcg / kg / hour.

Epidural anesthesia carried out in a dose of 0.1-1.15 mg / kg, previously diluted Promedol in 2-4 ml of sodium chloride for injection. The onset of the effect of the procedure is observed after 15-20 minutes, the peak of action occurs after about 40 minutes, with a gradual decrease in effectiveness over 8 hours or more.

Overdose

In case of an overdose of Promedol, the main negative effect is oppression of consciousness and respiratory depression, up to coma. Various enhanced side effects may also occur. A characteristic sign of diagnosing an overdose may be miosis (narrowing of the pupils).

Recommended pulmonary ventilation and its further support, as well as in / in the introduction antidote- Naloxone and subsequent symptomatic therapy.

Interaction

During the parallel use of promedol with sleeping pills and sedativesanxiolytics antipsychotics, muscle relaxantsethanol means general anesthesia and others narcotic analgesicsis amplified CNS and respiratory depression.

With systematic administration barbiturates, especially Phenobarbitalobserved a decrease in analgesic effects trimeperidine.

Promedol may increase effectiveness antihypertensive drugs (diuretics, ganglion blockersetc.).

Antidiarrhealand anticholinergicfunds can lead to urinary retentionheavy constipation, intestinal obstruction.

Trimeperidineenhances the effects of drugs with anticoagulantactivity, in connection with which, when used together, control is necessary prothrombin plasma.

Therapy with buprenorphinecurrently present or conducted earlier reduces the effect of Promedol.

Combined treatment with MAO inhibitors may cause severe consequences associated with brakingor overexcitation of the central nervous system and lead to development antihypertensiveor hypertensive crises.

Effects Metoclopramide decrease when it is taken with Promedol.

Naloxonebeing an antidote trimeperidineeliminates its side effects: breath suppressionanalgesia CNS depression. At drug addiction accelerates the development of symptoms "withdrawal syndrome«.

Naltrexone also affects the acceleration of symptoms "withdrawal syndromeAt drug addiction. After the introduction of the drug, persistent and difficult to eliminate symptoms appear fairly quickly, sometimes after 5 minutes, and are observed for 2 days.

Terms of sale

To purchase this drug, you need a correctly filled Promedol prescription in Latin, on the form prescribed by the rules, with all the details and seals attached.

Storage conditions

Both the injection solution and Promedol tablets are on the list A. The storage temperature of the drug is 8-15 ° C.

Shelf life

For tablets and solution - 5 years.

Special instructions

During therapy with Promedol, it is better to refrain from delicate and dangerous work, as well as from driving a car.

With the systematic use of Promedol may develop drug addiction.

For children

It is prescribed for children after 2 years, strictly according to indications, in precisely recommended doses, with extreme caution and under the supervision of a doctor.

With alcohol

Treatment with Promedol can not be combined with the intake of alcoholic beverages.

In pregnancy (and lactation)

In periods of pregnancy(except in cases of the onset of labor, in which the drug is indicated as an anesthetic and stimulant), as well as during breastfeeding Promedol is prescribed with extreme caution, taking into account all the possible negative effects of therapy for the mother, fetus or newborn.

Reviews

Reviews of doctors using Promedol in their practice, as well as reviews of patients using this drug in order to stop the strong pain syndrome, in 99% of cases are positive. The drug really has powerful analgesic effect for pain of various origins, it is noticeably effective as antispasmodicand even part of some first-aid kits, like antishock agent.

But at the same time, like any potent medicine, it has serious side effects: respiratory depression, oppression CNS, addictive. In this regard, when choosing narcoticanesthetic, you must first understand what it is, how to take it and what consequences it can lead to. You should not rely on information about the drug Promedol on Wikipedia, trust dubious Internet resources and the advice of friends. The decision to use Promedol, and similar drugs, can only be made by a qualified medical specialist, as well as explain all the positive and negative aspects of therapy.

Promedol price, where to buy

The approximate price of Promedol in Russia is: in the form of a 1% injection solution No. 10 - 400 rubles and in the form of a 2% injection solution No. 10 - 500 rubles.

You can buy 10 tablets of the drug at a price of about 200 rubles.

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