Why is Demerol (Pethidine) not used for cancer pain?

Dolantin refers to pethidine hydrochloride, commonly available in injectable and tablet forms. It is a potent analgesic frequently used to relieve moderate to severe pain. Generally, pethidine hydrochloride is not recommended for cancer-related pain due to reasons including drug allergy or intolerance, interactions with other medications, history of substance abuse or dependence, coexisting medical conditions, and severe respiratory depression. The specific reasons are analyzed as follows:

1. Drug Allergy or Intolerance: Some patients may exhibit allergic reactions or intolerance to pethidine hydrochloride or similar drugs. Symptoms may include rash, difficulty breathing, or severe urticaria. In such cases, physicians will consider alternative medications for managing cancer pain.

2. Drug Interactions: Pethidine hydrochloride may interact with other medications. Particularly when used concomitantly with antidepressants, sedatives, or alcohol-containing substances, the risk of adverse effects may increase. If a patient is undergoing treatment with other drugs that could interact, physicians may opt for alternative appropriate analgesics.

3. History of Substance Abuse or Dependence: Pethidine hydrochloride is an opioid-like agent with potential risks of abuse and dependence. For patients with a history of substance misuse or dependency, physicians may choose alternative medications or adopt different treatment strategies to prevent further drug-related complications.

4. Coexisting Medical Conditions: Some patients may have other concurrent health issues, such as impaired liver or kidney function, or a history of epilepsy, which may affect the safety of using pethidine hydrochloride. In these situations, physicians will evaluate the patient's overall condition and select a more suitable analgesic.

5. Severe Respiratory Depression: As an opioid-type medication, pethidine hydrochloride can cause respiratory depression, especially at high doses. Therefore, its use in patients already experiencing severe respiratory depression may further increase this risk. Physicians will carefully weigh safety and efficacy and choose alternative appropriate pain management approaches.

In managing cancer pain, it is essential to rely fully on professional evaluation and guidance from physicians. Based on the patient’s individual circumstances, severity of pain, accompanying symptoms, and other factors, doctors will develop an appropriate pain management plan and select suitable pharmacological treatments.