Trimeperidine (Promedol) is a narcotic analgesic .
Promedol | |
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Procedureolum | |
Chemical compound | |
IUPAC | 1,2,5-Trimethyl-4-propionyloxy-4-phenylpiperidine hydrochloride |
Gross formula | C 17 H 25 NO 2 |
Molar mass | 275.39 g / mol |
CAS | |
Pubchem | |
Classification | |
Pharmacol. Group | Opioid Narcotic Analgesics |
ATH | |
Other names | |
Promedol | |
Content
General Information
Promedol is a synthetic derivative of 4- phenylpiperidine and, by chemical structure, can be considered as an analogue of the phenyl-N-methylpiperidine moiety of morphine . Promedol is a mixture of optical isomers (including diastereomers) at positions 2, 4, and 5 of the piperidine cycle. Thus, the maximum possible number of isomers of promedol is eight. The properties of individual isomers have been studied very little.
Promedol has strong analgesic activity. It is rapidly absorbed and acts both when taken orally and when administered parenterally .
By its effect on the central nervous system (CNS), promedol is close to morphine; it reduces the CNS perception of pain impulses, inhibits conditioned reflexes. Like other analgesics lowers the summing ability of the central nervous system, enhances the anesthetic effect of novocaine and other local anesthetics. It has a hypnotic effect (mainly in connection with the removal of pain). Compared with morphine, the respiratory center is less depressed, the vagus nerve center and the vomiting center are less energized. It has a moderate antispasmodic effect on the smooth muscles of the internal organs and at the same time increases the tone and strengthens the contractions of the muscles of the uterus.
Promedol is used as an analgesic for serious injuries and various diseases accompanied by severe pain, in preparation for operations and in the postoperative period, etc. It is very effective in gastric ulcer and duodenal ulcer , angina pectoris , myocardial infarction , intestinal, hepatic and renal colic, dyskinetic constipation and other diseases in which pain syndrome is associated with spasms of smooth muscles of the internal organs and blood vessels.
In obstetric practice is used for anesthesia and speed up childbirth; In usual doses, promedol does not have any adverse effects on the mother and fetus.
Assign under the skin, intramuscularly and inside. For parenteral use, the analgesic effect is more pronounced. If necessary, also injected into the vein.
Inside, adults are prescribed to take on 0,025—0,05 g, under the skin - 1 ml of 1% or 2% solution, with severe pain, especially in patients with malignant tumors, with severe injuries, etc., administered 1-2 ml of 2% solution.
Higher doses for adults inside: single 0.05 g, daily 0.2; under the skin: single 0.04 g, daily 0.16 g
For children older than 2 years, promedol is prescribed in an amount of 0.003–0.01 g at the reception (by mouth and injections) depending on age; in children under 2 years of age, the drug is not used.
The action of promedol occurs in 10-20 minutes and usually continues after a single dose for 3-4 hours or more.
For pain associated with spasms of smooth muscles (angina pectoris, hepatic, renal, intestinal colic, etc.), promedol can be prescribed together with anticholinergic and antispasmodic agents: atropine , metacin, papaverine , etc.
Promedol is widely used in anesthesia practice. It is one of the main components of sedation . For sedation is injected subcutaneously or intramuscularly 0.02–0.03 g (1–1.5 ml of 2% solution) together with 0.0005 g (0.5 mg) of atropine 30–45 minutes before surgery. For emergency sedation drugs are injected into a vein. During anesthesia, promedol is used as an anti-shock agent in fractional doses of intravenous, 3-5–10 mg. Introduction of promedol, slightly deepening the anesthesia, enhances analgesia, which helps to reduce tachycardia and normalize blood pressure. Promedol can be used together with neuroleptic, antihistamine preparations, anticholinergics with general and local anesthesia. In combination with droperidol or other neuroleptics, promedol is used for central analgesia.
In the postoperative period, promedol is used (in the absence of respiratory disorders) to relieve pain and as an antishock agent. Enter 1 ml of 1% or 2% solution under the skin alone or in combination with dimedrol (see).
Promedol is suitable for use in anesthesiology, as it is relatively weak respiratory depression. His lack of spasmogenic effect on smooth muscles and sphincters (and even the presence of an antispasmodic action) reduces the possibility of urinary retention and gas in the intestine in the postoperative period.
For anesthesia of labor, promedol is injected under the skin with 1–2 ml of a 2% solution with a pharynx opening of 1.5–2 fingers and with a satisfactory fetus (with a normal rhythm and heart rate); if necessary, repeat the injection after 2-3 hours.
As an analgesic agent, the drug was part of an individual AI-2 first - aid kit (slot No. 1, syringe tube with 1 ml of promedol 2%).
Side Effects
Promedol is usually well tolerated. In rare cases, there may be mild nausea, sometimes dizziness, weakness, a feeling of light intoxication.
These phenomena pass independently. If side effects occur with repeated use of the drug, it is necessary to reduce the dose.
When using promedol may develop addiction .
Contraindications
Promedol is contraindicated in respiratory depression. Hypersensitivity, depression of the respiratory center; with epidural and spinal anesthesia - a violation of blood coagulation (including against the background of anticoagulant therapy), infection (risk of infection in the central nervous system); diarrhea with pseudomembranous colitis due to cephalosporins, linkosamides, penicillins, toxic dyspepsia (slowing down the elimination of toxins and the associated exacerbation and prolongation of diarrhea); simultaneous treatment with MAO inhibitors (including for 21 days after their use). Carefully. Abdominal pain of unknown etiology, surgical interventions on the gastrointestinal tract, urinary system, bronchial asthma, COPD, convulsions, arrhythmias, arterial hypertension, CHF, respiratory failure, hepatic and / or renal failure, myxedema, hypothyroidism, adrenal insufficiency, inhibition of hearth syndrome, hearth syndrome, hearth syndrome , TBI, prostatic hyperplasia, suicidal tendency, emotional lability, drug addiction (including a history of), severe inflammatory bowel disease, structures urethra, alcoholism, cachexia, pregnancy, lactation, old age, children's age.
Literature
- Mashkovsky M. D. Medicinal products. - 15th ed. - M .: New Wave, 2005. - p. 152-153. - 1200 s. - ISBN 5-7864-0203-7 .