Phenoperidine

Conjugate addition of norpethidine (81) to benzoylethylene gives the ketone, 93. Reduction of the carbonyl group to the alcohol affords the potent analgesic phenoperidine (94). ... 

Phenmetrazine 260 Phenobarbital 1, 268 Phenol phthal ei n 1, 316 Phenomorphan 294 Phenoperidine 302... 

Phenoperidine Hydrochloride 1207 Chemical Abstracts Registry No. 134-49.6 1707-14-8 (Hydrochloride)... 

C 4H2(,C1N02 24465-45-0) see Phenoperidine phenyl 2-piperidinoethyl ether hydrochloride (CnH iClNO 92196-25-3) see Raloxifene hydrochloride trfl s-4-phenyl-L-proline (C11H13NO2 96314-26-0) see Fosinopril... 

The combination of pethidine with monoamine oxidase inhibitors (MAOIs) can cause serious adverse reaction, which can present in two distinct forms. The excitatory form is characterised by sudden agitation, delirium, headache, hypo- or hypertension, rigidity, hyperpyrexia, convulsions and coma. It is thought to be caused by an increase in cerebral 5-HT concentrations because of inhibition of monoamine oxidase. This is potentiated by pethidine, which blocks neuronal uptake of 5-HT. The depressive form, which is frequently severe and fatal, consists of respiratory and cardiovascular depression and coma. It is the result of the inhibition of hepatic microsomal enzymes by the MAOI, leading to accumulation of pethidine. Phenoperidine should also be avoided in patients taking MAOI drugs but other opioids appear to be safe. 

The biotransformation of the phenylpiperidines is primarily by hepatic phase I metabolism, catalysed by cytochrome P-450 isoenzymes. The elimination of alfentanil is significantly slowed in patients treated with erythromycin, a P-450 inhibitor, with delayed recovery and prolonged postoperative respiratory depression (Bartkowski and McDonnell 1990). Apart from pethidine and phenoperidine, none of the phenylpiperidines has pharmacologically active metabolites. 

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