In this short snipet we explore the drug Methoxyflurane marketed as Penthrox
This drug is a volatile anaesthetic analgesic, it was abandoned in general anaesthesia during the 1970s because of its association with hepatic and kidney failure, but in low doses is an effective safe analgesic.
Most nurses working in emergency departments will be familiar with the classic image of a patient sucking on what looks like a green whistle, being wheeled into a department by paramedics.
The dose of 3ml of Penthrox is inserted into the "whistle" where it rapidly vaporises, is inhaled, and crosses the respiratory membrane diffusing into systemic circulation. Being highly fat soluble, it crosses the Blood brain barrier and acts on the
Pain relief begins after 6–8 breaths and continues for several minutes after stopping inhalation. Continuous use of methoxyflurane 3 mL provides analgesia for up to 25 minutes; a second 3 mL dose can be administered if required for up to 1 hour's analgesia. No more than 6 mL should be given in 1 day.
It is a depressant which can cause euphoria, and drowsiness, and like most central nervous system analgesics, respiratory depression is likely.
Points to remember.
- Methoxyflurane provides rapid-onset short-term analgesia for:
— initial management of acute trauma pain
— brief painful procedures such as wound dressing. - The disposable, single-use inhaler device allows patients (including children) to self-administer the drug, under supervision.
- Avoid use in children aged under 5 years and those unable to self-administer.
- Only use methoxyflurane in conscious, haemodynamically stable patients.
- Methoxyflurane is nephrotoxic at high doses:
— do not exceed maximum doses — 6 mL per day or 15 mL per week
— do not use on consecutive days. - Do not use in patients with renal impairment.
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