Various drugs than but with either less potency, or slight variation in their spectrum of pethidine cns excitation are included.
Phenyl piperidines: Meperidine, phenoperidine
Diphenyl compounds: Methadone, dextropropoxyphene
Miscellaneous: Oxycodeine, hydrocoedine
There are specific differences of these drugs as per their clinical importance of pethidine cns excitation. The equianalgesic dosages and potencies of various opioids are compared.
All the actions of morphine are seen here except in toxicity; pethidine cns excitation phenomena is seen commonly in tremors, rigidity, muscle seizures and convulsions.
These effects of pethidine are due to its metabolite norpethidine which through extra pyramidal system produces these effects.
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Due to atropine-mimicking structure—atropine-mimicking actions, may cause tachycardia. It also produces negative inotropic effect, leading to decreased myocardial contractility and reduced stroke volume. In addition due to atropine-like action two effects are commonly seen: Less of biliary spasm, mydriasis rather than miosis.
The patients on chronic use of mono amine oxidase (MAO) inhibitors, when administered pethidine show severe drug interactions: severe respiratory depression or excitation, delirium, hyperpyrexia, pethidine cns excitation and convulsions.
No other opioid shows these reactions. Phenothiazines and tricyclics potentiate respiratory depression produced by pethidine.