Pethidine Diazepam

Diazepam is a prescription-only medicine whereas pethidine, morphine, alfentanil and remifentanil are controlled drugs. 

Rectal pethidine is not advised in children, owing to enormous variability in systemic availability (SEDA-18, 82). When used for sedation in children undergoing eso-phagogastroduodenoscopy, hypoxia with dysrhythmias was more likely to occur with a combination of pethidine and diazepam than with pethidine and midazolam (SEDA-18, 81). 

GC-MS methods provide greater specificity and in many cases sensitivity when compared with more conventional techniques. They offer increased scope for the study of pharmacokinetics and of plasma concentration in relation to biological effect. SIM assay has been applied to the investigation of placental transfer of lipid soluble drugs and their subsequent elimination in the newborn (barbiturates, diphenylhydantoin, caffeine, pethidine and diazepam [122,408] diphenylhydantoin [411] amylobarbitone and 3 -hydroxyamylobarbitone [83,423]). 

A 26-year-old woman undergoing bronchoscopy received lidocaine jelly 2% to each nostril, lidocaine solution 2% sprayed on the throat, and 10 ml of lidocaine solution 2% into the trachea. She was also given intravenous diazepam 5 mg and pethidine 75 mg and intramuscular atropine 0.6 mg. She developed dyspnea and cyanosis after the procedure and despite 100% oxygen, her Sp02 was 85%. Her methemoglobin concentration was 14%. 

The treatment of addiction to certain drugs utilises substitution therapy. This is where the drug that the patient is addicted to is substituted for another drug that may be prescribed on a prescription form. Drugs allowed as substitutes are (most commonly) methadone, buprenor-phine, dextromoramide, morphine and pethidine. In addition, it is possible for prescribers to prescribe diazepam on instalment prescriptions for the management of side-effects to addiction treatment. 

Intramuscular pethidine 100 mg and intramuscular morphine 10 mg delayed the absorption of oral diazepam 10 mg. Diazepam levels were found to be lower and peak levels were not reached in the 90-minute study period, when compared with the peak level at 60 minutes in the eontrol group.The underlying mechanism is that the opioid analgesics delay gastric emptying so that the rate of absorption of the diazepam is reduced. The maximal effect of diazepam would be expected to be delayed in patients receiving these opioids. 

In contrast, intravenous diazepam 150 micrograms/kg did not alter the respiratory depressant effect of intravenous pethidine 1.5 mg/kg in a study in healthy subjects or in patients with chronic obstructive pulmonary disease. Moreover, in the setting of overdose (see (b) above), benzodiazepines might increase the respiratory depressant effects of opioids. 

In a multicenter, double-blind, placebo-controlled study of the effects of intravenous flumazenil 0.7 mg in reversing the effects of midazolam, 82% of 131 flumazenil-treated patients had complete reversal of sedation, compared with 15% of 65 placebo-treated patients. However, flumazenil reversed midazolam-induced amnesia in only 60% of patients. Dizziness (10%) and nausea (9%) were the most common adverse effects [96 ]. Similar results were obtained in a double-blind, placebo-controlled study in patients who had been given midazolam plus an opioid (fentanyl, pethidine, or morphine) [97 ], intravenous diazepam [98 "], or diazepam plus an opioid [99 ]. 

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