Meperidine / promethazine Pregnancy and Breastfeeding Warnings

Meperidine / promethazine is also known as: Mepergan, Mepergan Fortis, Meprozine

Meperidine / promethazine Pregnancy Warnings

Meperidine has not been formally assigned to a pregnancy category by the FDA. It has been frequently used in pregnancy and during labor. Meperidine and normeperidine cross the placenta very rapidly and may cause respiratory depression and lower psychophysiologic test scores in newborns if it is administered to the mother shortly before delivery. Infants of chronic users may experience withdrawal. There are no controlled data in human pregnancy. Meperidine should only be given in pregnancy when benefit outweighs risk. Promethazine has not been formally assigned to a pregnancy category. Several retrospective studies have suggested that there is no increased risk of congenital malformations in humans with use of promethazine in pregnancy. Promethazine has been shown to impair neonatal platelet aggregation when given during labor. There are no controlled data in human pregnancy. Promethazine should only be given during pregnancy when there are no alternatives and benefit outweighs risk.

Meperidine / promethazine Breastfeeding Warnings

Meperidine is excreted into human milk in small amounts. The concentrations achieved are probably clinically insignificant although one study has reported an increased incidence of apneic events in breast-fed infants whose mothers take opioids (including meperidine) while nursing. The American Academy of Pediatrics has no position on the use of meperidine during breast-feeding but considers morphine and other narcotics to be compatible with breast-feeding. There are no data on the excretion of promethazine into human milk. However, passage of the drug into breast milk is expected.

One study has reported that normeperidine levels are persistently elevated in breast milk. The elevation in metabolite levels has been suggested as an explanation for the fact that neonates whose mothers are treated with meperidine exhibit greater neurobehavioral depression than neonates whose mothers are treated with morphine.

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