WARNINGDANGER OF DEATH
High doses alone or ordinary doses in combination with other depressants can fatally stop breathing.
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Pethidine
Dosage & Duration
Dosage
Doses are population estimates that vary widely between individuals.
Duration
Subjective Effects
Pharmacology
Dangerous
Highest riskThese combinations are considered extremely harmful and should always be avoided. Reactions to these drugs taken in combination are highly unpredictable and have a potential to cause death.
Caution
Use cautionThese combinations are not usually physically harmful, but may produce undesirable effects, such as physical discomfort or overstimulation. Extreme use may cause physical health issues. Synergistic effects may be unpredictable. Care should be taken when choosing to use this combination.
Tolerance
Harm Potential
Addiction & Dependence
Psychological
Extremely HighChronic pethidine use is described as extremely addictive with high abuse potential and capable of causing psychological dependence, cravings, and withdrawal symptoms.
Physical
HighProlonged pethidine use may lead to morphine-type dependence with withdrawal symptoms, and pethidine can cause physical dependence.
Toxicity
Pethidine has high toxicity relative to dose, can be fatal in overdose, and is potentially lethal with depressants such as alcohol or benzodiazepines. Severe overdose can cause coma or death without immediate medical attention.
High doses and overdose may cause respiratory depression, abnormal breathing, unconsciousness, coma, cold clammy skin, hypotension, obtundation, and death.
High doses may cause seizures, and chronic parenteral use has been associated with convulsive seizures.
Serotonin syndrome has occurred with antidepressants and MAOIs and can include agitation, hyperpyrexia, hypertension, tachycardia, seizures, coma, and death.
Meperidine can pass through the placenta and enter breast milk.
Psychosis Risk
Overdose can cause psychosis, and norpethidine is described as hallucinogenic and associated with delirium and dysphoria.
Seizure Risk
High doses may cause seizures through norpethidine accumulation, and serious interactions with MAOIs or tramadol can also produce convulsions.
History & Culture
Legality
International
1961 Single Convention (as amended): Pethidine (meperidine), chemically 1-methyl-4-phenylpiperidine-4-carboxylic acid ethyl ester (the same identity as ethyl 1-methyl-4-phenylpiperidine-4-carboxylate), is expressly in Schedule I; Schedule-I isomers, esters/ethers (unless in another Schedule), and their possible salts are also controlled. It is not in Schedule IV, and no pethidine preparation is listed in Schedule III.
1971 Convention on Psychotropic Substances: Pethidine/meperidine and its stated chemical identity are not listed in any of Schedules I, II, III or IV in the complete current Green List; therefore the Convention's salts and stereoisomer provisions do not transfer control to pethidine.
1988 Convention against Illicit Traffic: Pethidine/meperidine and its stated chemical identity are not listed in either Table I or Table II in the complete current official Tables (as at 3 December 2024); no applicable class, derivative, isomer, salt, ester or preparation entry was identified. The separately listed piperidone/fentanyl-precursor entries do not establish control of pethidine.
By Country
References
Source Pages
Citations
Further Reading
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