Meperidine Pregnancy and Breastfeeding Warnings
Meperidine Pregnancy Warnings
Meperidine has been assigned to pregnancy category C 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 during pregnancy if clearly needed.
Meperidine Breastfeeding Warnings
Meperidine is excreted into human milk. One study has reported an increased incidence of apneic events in breastfed infants whose mothers take opioids (including meperidine) while nursing. Due to the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
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. One report on concentrations in breast milk of medications used during general anesthesia has stated that meperidine was present in both milk and blood during the recovery period but not at 24 hours. This report stated that infant exposure indices ranged from 1.2% to 3.5% for meperidine. Therefore, the authors concluded that the amount of meperidine excreted into breast milk when used for general anesthesia does not warrant interruption in breast-feeding.
References for pregnancy information
- Hodgkinson R, Husain FJ "The duration of effect of maternally administered meperidine on neonatal neurobehavior." Anesthesiology 56 (1982): 51-2
- Aaen V, Cowan L, Sakala EP, Small ML "Prolonged parenteral meperidine analgesia during pregnancy for pain from an abdominal wall mesh graft." Obstet Gynecol 82 (1993): 721-2
- Jackson MB, Robson PJ "Preliminary clinical and pharmacokinetic experiences in the newborn when meptazinol is compared with pethidine as an obstetric analgesic." Postgrad Med J 59 (1983): 47-51
- Notarianni LJ "Placental transfer of pethidine and bupivacaine." Neuropharmacology 20 (1981): 1253-8
- Morgan D, Moore G, Thomas J, Triggs E "Disposition of meperidine in pregnancy." Clin Pharmacol Ther 23 (1978): 288-95
- Kuhnert BR, Kuhnert PM, Philipson EH, Syracuse CD "Disposition of meperidine and normeperidine following multiple doses during labor II: fetus and neonate." Am J Obstet Gynecol 151 (1985): 410-5
- Koren G, Pastuszak A, Ito S "Drugs in pregnancy." N Engl J Med 338 (1998): 1128-37
- Edwards DJ, Svensson CK, Visco JP, Lalka D "Clinical pharmacokinetics of pethidine: 1982." Clin Pharmacokinet 7 (1982): 421-33
- Kuhnert BR, Kuhnert PM, Prochaska AL, Sokol RJ "Meperidine disposition in mother, neonate, and nonpregnant females." Clin Pharmacol Ther 27 (1980): 486-91
- Heinonen O, Slone D, Shapiro S; Kaufman DW ed. "Birth Defects and Drugs in Pregnancy." Littleton, MA: Publishing Sciences Group, Inc. (1977): 297
- Kuhnert BR, Kuhnert PM, Tu A-S, et al "Meperidine and normeperidine levels following meperidine administration during labor I: mother." Am J Obstet Gynecol 133 (1979): 904-8
- Todd EL, Stafford DT, Bucovaz ET, Morrison JC "Pharmacokinetics of meperidine in pregnancy." Int J Gynaecol Obstet 29 (1989): 143-6
References for breastfeeding information
- Borgatta L, Jenny RW, Gruss L, Ong CK, Barad D "Clinical significance of methohexital, meperidine, and diazepam in breast milk." J Clin Pharmacol 37 (1997): 186-92
- Committee on Drugs, 1992 to 1993 "The transfer of drugs and other chemicals into human milk." Pediatrics 93 (1994): 137-50
- Roberts RJ, Blumer JL, Gorman RL, et al "American Academy of Pediatrics Committee on Drugs: Transfer of drugs and other chemicals into human milk." Pediatrics 84 (1989): 924-36
- Spigset O "Anaesthetic agents and excretion in breast milk." Acta Anaesthesiol Scand 38 (1994): 94-103
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