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Meptazinol oral

Updated 2 Feb 2023 | Opioid analgesics

Presentation

Oral formulations of meptazinol

Drugs List

  • meptazinol 200mg tablets
  • MEPTID 200mg tablets
  • Therapeutic Indications

    Uses

    Pain - moderate

    Dosage

    Adults

    200 mg every 3 to 6 hours as required.

    The usual dose is 200 mg every 4 hours.

    Elderly

    200 mg every 3 to 6 hours as required.

    The usual dose is 200 mg every 4 hours.

    Patients with Renal Impairment

    The Renal Handbook suggests patients with a GFR (ml/min) of 10 and above should receive the same dose as patients with normal renal function. Patients with a GFR (ml/min) of less than 10 should receive doses equivalent to patients with normal renal function but should be started on low doses.

    Contraindications

    Acute alcohol intoxication
    Children under 18 years
    Predisposition to paralytic ileus
    Within 2 weeks of discontinuing MAOIs
    Acute asthma
    Acute respiratory depression
    Chronic obstructive pulmonary disease
    Coma
    Head trauma
    Myocardial infarction
    Phaeochromocytoma
    Raised intracranial pressure

    Precautions and Warnings

    Debilitation
    Shock
    Adrenal insufficiency
    Asthma
    Biliary tract disorder
    Breastfeeding
    Hepatic impairment
    Hypotension
    Hypothyroidism
    Inflammatory bowel disease
    Moderate renal impairment
    Myasthenia gravis
    Pregnancy
    Prostate disorder
    Respiratory impairment
    Seizures
    Urethral stricture

    Consider dose modification in patients with respiratory depression
    Reduce dose in hypothyroidism
    Reduce dose in patients with hepatic impairment
    Reduce dose in patients with moderate renal impairment
    Advise patient ability to drive or operate machinery may be impaired
    Advise patient not to drive until they know how the medicine affects them
    Advise patient this medicine may be subject to driving restrictions
    Contains sunset yellow (E110) - may cause allergic reaction
    Tolerance and dependence may occur
    Potential for withdrawal symptoms
    Avoid abrupt withdrawal
    Reduce dose in debilitated patients
    Only recommended for short term use

    Pregnancy and Lactation

    Pregnancy

    Use meptazinol with caution in pregnancy.

    Manufacturer advises that meptazinol tablets should only be given in pregnancy if clearly necessary.

    As meptazinol is less tried than other opioid analgesics, if an opioid is warranted, other established agents e.g. tramadol or pethidine, should be used instead. The use of meptazinol in the first trimester is not seen as a valid reason for the termination of a pregnancy or for the deployment of invasive diagnostic procedures (Schaefer, 2007).

    When tested on pregnant animals, meptazinol did not show any evidence of teratogenic effects. Likewise, no congenital anomaly is known from the anecdotal human experience with opioid analgesics, and Lee (2000) even conclude that opioids are fully compatible with pregnancy as therapeutic doses are unlikely to have any adverse effect on foetal development (Lee, 2000). It should be noted, however, that no adequate and well-controlled clinical studies in humans were available for meptazinol at the time of writing.

    Therapy with opioid analgesics during pregnancy is generally associated with the following risks to mother and foetus: pregnant women taking opiates during labour may suffer such adverse reactions as gastric stasis and inhalation pneumonia, while the baby may develop withdrawal symptoms if the mother uses opiates regularly throughout the pregnancy (Lee, 2000). These withdrawal symptoms will typically include: feeding intolerance, diarrhoea, vomiting, tachypnoea, hypertonia, hyperexcitability, high-pitched cry, tremor and, in severe cases, convulsions (Lee, 2000; Schaefer, 2007). The newborn may also be exposed to respiratory depression if the mother receives doses within days of delivery (Schaefer, 2007).

    Meptazinol crosses the placenta.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

    Lactation

    Use Meptazinol with caution in breastfeeding.

    Manufacturer recommends that meptazinol should only be administered during lactation with caution. There is effectively very limited information on the use of meptazinol during lactation and other, more established opiates should probably be preferred (Schaefer, 2007).

    Opiates may all be excreted into breast milk. No quantitative data are available for meptazinol as of the revision date, however given the slower metabolism of opioids in infants, it is very likely that accumulation will occur if the nursing infant is chronically exposed to even small amounts of drug (Lee, 2000).

    Lee (2000) advise that mothers on opiate therapy should breastfeed immediately before taking a dose so as to avoid peak concentrations in milk.

    LactMed suggests infants exposed to opiates via breast milk may generally experience the following side effects: cyanosis, breathing difficulty, increased sleepiness, limpness, difficulty breastfeeding.

    LactMed indicates certain opioid agents may increase serum prolactin.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

    Effects on Ability to Drive and Operate Machinery

    This class of medicine is in the list of drugs included in regulations under 5a of the Road Traffic Act 1988 (England and Wales). This medicine may be subject to police testing and has specified maximum blood levels for driving.
    When prescribing this medicine: Advise patient the medicine can affect cognitive function and is likely to affect ability to drive. Advise patient not to drive until they know how the medicine affects them.
    It is an offence to drive while under the influence of this medicine. However, a patient is not committing an offence (called 'statutory defence') if: 1. The medicine has been prescribed to treat a medical or dental problem and 2. The medicine has been taken according to the instructions given by the prescriber and/or in the information provided with the medicine, and 3. The medicine was not affecting the ability to drive safely. For further guidance see https://www.gov.uk

    Side Effects

    Abdominal pain
    Biliary spasm
    Bradycardia
    Confusion
    Constipation
    Dependence
    Depression
    Diarrhoea
    Difficulty in micturition
    Dizziness
    Drowsiness
    Dry mouth
    Dyspepsia
    Dysphoria
    Euphoria
    Facial flushing
    Hallucinations
    Headache
    Hypotension
    Hypothermia
    Miosis
    Mood changes
    Muscle rigidity
    Nausea
    Oedema
    Palpitations
    Postural hypotension
    Pruritus
    Rash
    Reduced libido
    Reduction of male potency
    Respiratory depression
    Sexual dysfunction
    Sleep disturbances
    Somnolence
    Sweating
    Tachycardia
    Tolerance
    Ureteric spasm
    Urinary retention
    Urticaria
    Vertigo
    Visual disturbances
    Vomiting
    Withdrawal symptoms

    Overdosage

    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

    Further Information

    Last Full Review Date: August 2016

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Joint Formulary Committee. British National Formulary(online) London: BMJ Group and Pharmaceutical Press Accessed on 05 August 2016.

    Summary of Product Characteristics: Meptid Tablets. Almirall Ltd. Revised June 2015.

    Therapeutics in Pregnancy and Lactation (2000) Lee, A., Inch, S. and Finnigan, D. Radcliffe Medical Press, Abingdon.

    Gov.uk. Government departments. Department for Transport. Publications. Drug driving and medicine: Advice for healthcare professionals. Drug driving: Guidance for healthcare professionals on drug driving. Available at: https://www.gov.uk/ Last accessed: 5 August 2016

    New drug driving offence implications for medicines packaging. Medicines Regulatory News. 10 December 2013. Available at: https://www.mhra.gov.uk Last accessed: 5 August 2016

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
    Morphine Last revised: 04 February 2016
    Last accessed: 05 August 2016

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