Almirall Limited

Meptid 100 mg/ml Solution for Injection

Each 1 ml of solution contains 100 mg of meptazinol (as hydrochloride).

For a full list of excipients, see section 6.1.

Solution for Injection.

A clear colourless solution free from particulate matter.

For the treatment of moderate to severe pain, including post-operative pain, obstetric pain and the pain of renal colic.

Adults

Intramuscular dosage: 75 to 100 mg meptazinol. This injection may be repeated 2 to 4 hourly as required. For obstetric pain a dose of 100 to 150 mg should be used according to weight. This dose should approximate 2 mg/kg.

Adults

Intravenous dosage: 50 to 100 mg meptazinol by slow intravenous injection. The injection may be repeated 2 to 4 hourly as required. If vomiting occurs, a suitable antiemetic should be given.

Epidural/intrathecal use: this formulation is not suitable for these routes.

Elderly

The adult dosage schedule can be used in the elderly.

Children

Meptid Injection has not been evaluated for use in children.

Patients with the following conditions:

• known hypersensitivity to the active ingredient or to any of the excipients

• acute alcoholism and where there is a risk of paralytic ileus

• raised intracranial pressure or head injury (in addition to interfering with respiration, affects pupillary responses vital for neurological assessment)

• phaeochromocytoma (risk of pressor response to histamine release)

• acute respiratory depression

• during an asthma attack

• patients on monoamine-oxidase inhibitors (MAOIs) and for 14 days after discontinuing an MAOI. (see section 4.5)

Caution should be exercised in patients whose respiratory system is already compromised.

Patients with moderate to severe renal impairment should be given a reduced dose as the effect in these patients may be prolonged and increased. Cerebral sensitivity may also be increased. Patients with hepatic impairment should be given a reduced dose as opioid analgesics may precipitate coma in these patients.

Since safety in long term use is not known it is recommended that this drug be used in the treatment of acute pain only, apart from appropriate therapy in malignant conditions. Repeated administration of opioid analgesics may cause dependence and tolerance (severe withdrawal symptoms if withdrawn abruptly).

Safety for use in myocardial infarction has not been established.

Meptazinol should also be used with caution in patients with the following conditions: hypotension, hypothyroidism, asthma (avoid during an attack), prostatic hypertrophy and convulsive disorders.

The following undesirable effects could occur as a result of possible interaction with meptazinol hydrochloride:

Antidepressants: CNS excitation or depression manifesting as hypertension or hypotension may occur if meptazinol is administered to patients receiving MAOIs (including moclobemide). Avoid concomitant use for 14 days after an MAOI is discontinued (see section 4.3). Possible increased sedation if meptazinol is used with tricyclic antidepressants.

Antipsychotics: enhanced sedative and hypotensive effect.

Antivirals: avoid concomitant use with ritonavir as plasma concentration of meptazinol may be increased.

Alcohol: enhanced sedative and hypotensive effect.

Quinolones (ciprofloxacin): avoid premedication with meptazinol as a reduced plasma-ciprofloxacin concentration may be experienced.

Anxiolytics and hypnotics: enhanced sedative effect.

Drugs used in nausea and vomiting: concomitant use of metoclopramide and domperidone may result in antagonism of gastrointestinal side-effects.

Ulcer healing drugs: cimetidine may inhibit metabolism of meptazinol resulting in increased plasma concentration.

No clinical data on exposed pregnancies are available.

Animal studies do not indicate direct or indirect harmful effects with respect to pregnancy, embryonal/foetal development, parturition or postnatal development.

Meptid injection is a useful analgesic in labour, however, it should not be given in other stages of pregnancy unless considered essential by the physician.

Meptazinol should not be used during breast-feeding.

Since dizziness and occasionally drowsiness have been reported, patients should be cautioned against driving or operating machinery until it is established that they do not become dizzy or drowsy whilst taking meptazinol.

For very rare reports of psychiatric disorders (hallucination, confusion, depression), causal relationship with meptazinol has not been established and therefore omitted from the above table.

Reactions not already stated which are attributable to opioid analgesics include difficulty with micturition, ureteric or biliary spasm, dry mouth, facial flushing, bradycardia, tachycardia, palpitations, hypothermia, dysphoria, mood changes, miosis, decreased libido or potency, urticaria and pruritus.

Overdose with Meptid Injection has not been reported. Large doses, including seven times the recommended therapeutic dose, have been given in balanced and total intravenous anaesthesia without significant respiratory depressant effects.

In the event of cardiovascular and respiratory collapse, normal resuscitative procedures should be employed. Respiratory depression caused by overdosage with meptazinol may only be partially reversed with therapeutic doses of naloxone. Naloxone has a short duration of action in comparison with meptazinol. Repeated administration or administration by continuous intravenous infusion may be considered necessary.

Meptid (meptazinol) is a centrally acting analgesic belonging to the hexahydroazepine series, which has demonstrated mixed agonist and antagonist activity at opioid receptors.

Receptor binding studies have shown that although meptazinol displays only a low affinity for δ and κ opioid receptor sites, it has a somewhat higher affinity for a subpopulation of μ sites. These binding sites also display a high affinity for the endogenous opioid peptides, and are thought to be responsible for, among other things, analgesia, but not for the mediation of respiratory depression. A component of its analgesic action is also attributable, in mice at least, to an effect on central cholinergic transmission. In this respect it differs from all conventional analgesic drugs which have been examined.

After intramuscular administration, meptazinol is rapidly absorbed and peak plasma levels are reached within 30 minutes. The plasma half-life is approximately 2 hours. The peak analgesic effect is seen within 30-60 minutes and lasts about 3 - 4 hours. After intravenous administration, the onset of action is immediate, occurring within minutes and lasts a minimum of one hour.

The major route of metabolism is via the glucronidation pathway and excretion occurs mainly in the urine.

Standard toxicity tests revealed no unexpected finding of clinical significance.

Glucose anhydrous

Water for injection

Meptid Injection should not be mixed with other drugs in the same infusion solution or in the same syringe. Meptid Injection is an acidic solution of the hydrochloride salt of meptazinol and is therefore pharmaceutically incompatible with injection solutions known to be strongly basic (for example thiopentone) as precipitation of the meptazinol base may occur.

Unopened: 3 years.

Once opened: For single use only. Discard any unused contents.

Do not store above 25°C.

1 ml clear glass ampoules. The glass complies with the requirements of the European Pharmacopoeia Type 1. The ampoules will be packed in cartons of 10 and cartons of 1.

No special requirements

Almirall S.A.

Ronda General Mitre, 151

08022Barcelona

Spain

PA 968/5/1

Date of first authorisation: 10 October 1983

Date of last renewal: 25 August 2007

1 August 2010