Leitura clínica
Comentário
A meperidina ou petidina é um potente agonista opioide com propriedades analgésicas e sedantes que se utiliza para controlar a dor intensa. Administração oral, intramuscular ou intravenosa. É excretada no leite materno em quantidade muito escassa (Al-Tamimi 2011, Borgatta 1997, Wittels 1990, Quinn 1986, Peiker 1980) e, em geral, não foram observados problemas em lactentes cujas mães a tomavam (Al-Tamimi 2011). Os níveis no plasma desses lactentes foram muito baixos, em torno de 1% dos níveis maternos (Al-Tamimi 2011). Após uma cesárea, os recém-nascidos de mães tratadas com petidina para controlar a dor tiveram maiores sinais de depressão neurológica durante os três primeiros dias que os de mães tratadas com morfina (Reynolds 2011, Wittels 1997 e 1990). Os recém-nascidos de mães que receberam petidina, com relação aos de mães que receberam fentanilo, morfina ou nenhum fármaco analgésico, tiveram mais problemas para estabelecer a amamentação os primeiros dias, menor frequência inicial de amamentação ou maior cessação precoce de amamentação (Dejbakht 2021, Fan 2020, Hemati 2018, Fleet 2017 e 2015, Adams 2015, Wilson 2010, Yost 2004, Torvaldsen 2006, Ransjö 2001, Spigset 2000, Nissen 1997 e 1995, Rajan 1994, Lee 1993). Outros estudos não encontraram problemas de amamentação com o uso de petidina (Kinugasa 2019). A meperidina pode aumentar os níveis séricos de prolactina (Onur 1989). A eliminação do metabólito norpetidina é mais lenta, com um T½ de 20 horas, e maior (63 horas) no período neonatal (Dalal 2014, Lee 1993, Quinn 1986). Devido a essas considerações, embora a Academia Americana de Pediatria a considerasse uma medicação usualmente compatível com a amamentação (AAP 2001), posteriormente a desaconselhou (Sachs 2013), juntamente com outras sociedades científicas (Reece 2017, ASGE 2012, AGA 2012). Doses isoladas para procedimentos curtos é improvável que afetem o lactente (Reece 2017, WHO/UNICEF 2002). Evitar doses repetidas. Vigilar sedação e sucção fraca, especialmente no período neonatal (WHO/UNICEF 2002).
Encontrabilidade
Outros nomes e marcas
Sinônimos e grafias 6
- Isonipecaina
- Meperidina
- Πεθιδίνη, μεπεριδίνη
- Петидина Гидрохлорид
- ペチジン塩酸塩
- N02AB02
Marcas comerciais na fonte 10
- Cluyer
- Demerol
- Dolantina
- Dolcontral
- Dolosal
- Dornot
- Meperol
- Pamergan P100
- Pethidol
- Petinan
Dados da fonte
Farmacocinética
| Variável | Valor | Unidade |
|---|---|---|
| Biodisp. oral | 50 - 60 | % |
| Peso Molecular | 283 | daltons |
| Unión proteínas | 60 - 80 | % |
| Vd | 3,7 - 4,2 | l/Kg |
| pKa | 8,6 | - |
| Tmax | 0,5 - 0,9 | horas |
| T½ | 3 - 5. / Norpet.: 15 - 30 | horas |
| Índice L/P | 1,1 - 1,6 | - |
| Dosis Teórica | 0,01 - 0,17 | mg/Kg/d |
| Dosis Relativa | 0,6 - 3,5 | % |
| Dosis Rel. Ped. | 0,5 - 1,9 | % |
Rastreabilidade
Bibliografia
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