papaveretum

CLINICAL USE

Opiate analgesia

DOSE IN NORMAL RENAL FUNCTION

SC/IM: 0.5–1 mL every 4 hoursIV: 25–50% of dose

PHARMACOKINETICS

Papaverine Morphine Codeine Molecular weight (daltons)375.8375.8371.9% Protein binding9020–357% Excreted unchanged in urine<110<5Volume of distribution (L/kg)0.99–1.52 3–53–4half-life – normal/ESRD (hrs)1.2–2.2/– 2–3/ Un-changed2.5–4/–

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : 0.4–0.75 mL every 6–8 hours

<10 : 0.25–0.5 mL every 6–8 hours. Avoid if possible

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unlikely to be dialysed. Dose as in GFR <10 mL/min

HD :Unlikely to be dialysed. Dose as in GFR <10 mL/min

HDF/high flux :Unlikely to be dialysed. Dose as in GFR <10 mL/min

CAV/VVHD :Unknown dialysability. Dose as in GFR 10 to 20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anti-arrhythmics: delayed absorption of mexiletine

Antidepressants: possible CNS excitation or depression with MAOIs – avoid concomitant use; possible CNS excitation or depression with moclobemide; increased sedative effects with tricyclics

Antivirals: concentration possibly increased with ritonavirSodium oxybate: enhanced effect of sodium oxybate – avoid concomitant use

ADMINISTRATION

Reconstition

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Route

SC, IM, IV

Rate of Administration

IV bolus or continuous infusion (1 mg/mL)

Comments

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OTHER INFORMATION

As with all opiates, use with extreme caution in patients with impaired renal functionMay cause excessive sedation and respiratory depressionPapaveretum 15.4 mg =1 mL ≡ 10 mg morphine.

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