Pronunciation:

(me PER i deen)

U.S. Brand Names:

Synonyms:

Generic Available:

Canadian Brand Names:

Use:

Use - Dental:

Restrictions:

Pregnancy Risk Factor:

Pregnancy Implications:

Lactation:

Contraindications:

Warnings/Precautions:

Use with caution in patients with pulmonary, hepatic, renal disorders, or increased intracranial pressure; use with caution in patients with renal failure or seizure disorders or those receiving high-dose meperidine; normeperidine (an active metabolite and CNS stimulant) may accumulate and precipitate twitches, tremors, or seizures; some preparations contain sulfites which may cause allergic reaction; not recommended as a drug of first choice for the treatment of chronic pain in the elderly due to the accumulation of normeperidine; for acute pain, its use should be limited to 1-2 doses; tolerance or drug dependence may result from extended use. Use only with extreme caution (if at all) in patients with head injury or increased intracranial pressure (ICP); potential to elevate ICP may be greatly exaggerated in these patients.

Adverse Reactions:

Cardiovascular: Hypotension

Central nervous system: Fatigue, drowsiness, dizziness, nervousness, headache, restlessness, malaise, confusion, mental depression, hallucinations, paradoxical CNS stimulation, increased intracranial pressure, seizure (associated with metabolite accumulation)

Dermatologic: Rash, urticaria

Gastrointestinal: Nausea, vomiting, constipation, anorexia, stomach cramps, xerostomia, biliary spasm, paralytic ileus

Genitourinary: Ureteral spasms, decreased urination

Local: Pain at injection site

Neuromuscular & skeletal: Weakness

Respiratory: Dyspnea

Miscellaneous: Histamine release, physical and psychological dependence

Overdosage/Toxicology:

Drug Interactions:

Acyclovir: May increase meperidine metabolite concentrations. Use caution.

Barbiturates: May decrease analgesic efficacy and increase sedative and/or respiratory depressive effects of meperidine.

Cimetidine: May increase meperidine metabolite concentrations; use caution.

CNS depressants (including benzodiazepines): May potentiate the sedative and/or respiratory depressive effects of meperidine.

MAO inhibitors: Greatly potentiate the effects of meperidine; acute opioid overdosage symptoms can be seen, including severe toxic reactions. Concurrent use within 14 days of an MAO inhibitor is contraindicated.

Phenothiazines: May potentiate the sedative and/or respiratory depressive effects of meperidine; may increase the incidence of hypotension.

Phenytoin: May decrease the analgesic effects of meperidine

Ritonavir: May increase meperidine metabolite concentrations; use caution.

Serotonin agonists: Serotonin agonists may enhance the adverse/toxic effect of meperidine. Serotonin syndrome may occur.

Serotonin reuptake inhibitors: May potentiate the effects of meperidine; including severe toxic reactions

Tricyclic antidepressants: May potentiate the sedative and/or respiratory depressive effects of meperidine. In addition, potentially may increase the risk of serotonin syndrome.

Ethanol/Nutrition/Herb Interactions:

Ethanol: Avoid or limit ethanol (may increase CNS depression). Watch for sedation.

Food: Glucose may cause hyperglycemia; monitor blood glucose concentrations.

Herb/Nutraceutical: Avoid valerian, St John's wort, kava kava, gotu kola (may increase CNS depression).

Stability:

Incompatible with aminophylline, heparin, phenobarbital, phenytoin, and sodium bicarbonate

Compatibility:

Y-site administration: Compatible: Amifostine, amikacin, ampicillin, ampicillin/sulbactam, atenolol, aztreonam, bumetanide, cefamandole, cefazolin, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftizoxime, ceftriaxone, cefuroxime, chloramphenicol, cisatracurium, cladribine, clindamycin, co-trimoxazole, dexamethasone sodium phosphate, diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doxycycline, droperidol, erythromycin lactobionate, etoposide phosphate, famotidine, filgrastim, fluconazole, fludarabine, gatifloxacin, gemcitabine, gentamicin, granisetron, heparin, hydrocortisone sodium succinate, insulin (regular), kanamycin, labetalol, lidocaine, linezolid, magnesium sulfate, melphalan, methyldopate, methylprednisolone sodium succinate, metoclopramide, metoprolol, metronidazole, ondansetron, oxacillin, oxytocin, paclitaxel, penicillin G potassium, piperacillin, piperacillin/tazobactam, potassium chloride, propofol, propranolol, ranitidine, remifentanil, sargramostim, teniposide, thiotepa, ticarcillin, ticarcillin/clavulanate, tobramycin, vancomycin, verapamil, vinorelbine. Incompatible: Allopurinol, amphotericin B cholesteryl sulfate complex, cefepime, cefoperazone, doxorubicin liposome, idarubicin, imipenem/cilastatin, minocycline. Variable (consult detailed reference): Acyclovir, furosemide, nafcillin

Compatibility in syringe: Compatible: Atropine, atropine with hydroxyzine, atropine with promethazine, butorphanol, chlorpromazine, cimetidine, dimenhydrinate, diphenhydramine, droperidol, fentanyl, glycopyrrolate, hydroxyzine, ketamine, metoclopramide, midazolam, ondansetron, pentazocine, pentazocine with perphenazine, perphenazine, prochlorperazine edisylate, promazine, promethazine, ranitidine, scopolamine. Incompatible: Heparin, morphine, pentobarbital

Compatibility when admixed: Compatible: Cefazolin, dobutamine, metoclopramide, ondansetron, scopolamine, succinylcholine, triflupromazine, verapamil. Incompatible: Aminophylline, amobarbital, floxacillin, furosemide, heparin, morphine, phenobarbital, phenytoin, thiopental. Variable (consult detailed reference): Sodium bicarbonate

Mechanism of Action:

Pharmacodynamics/Kinetics:

Onset of action: Analgesic: Oral, SubQ, I.M.: 10-15 minutes; I.V.: ~5 minutes

Peak effect: Oral, SubQ, I.M.: ~1 hour

Duration: Oral, SubQ, I.M.: 2-4 hours

Distribution: Crosses placenta; enters breast milk

Protein binding: 65% to 75%

Metabolism: Hepatic; active metabolite (normeperidine)

Bioavailability: ~50% to 60%; increased with liver disease

Half-life elimination:

Parent drug: Terminal phase: Neonates: 23 hours (range: 12-39 hours); Adults: 2.5-4 hours, Liver disease: 7-11 hours

Normeperidine (active metabolite): 15-30 hours; can accumulate with high doses or with decreased renal function

Dosage:

Children: Pain: Oral, I.M., I.V., SubQ: 1-1.5 mg/kg/dose every 3-4 hours as needed; 1-2 mg/kg as a single dose preoperative medication may be used; maximum 100 mg/dose

Adults: Pain:

Oral: Initial: Opiate-naive: 50 mg every 3-4 hours as needed; usual dosage range: 50-150 mg every 2-4 hours as needed

I.M., SubQ: Initial: Opiate-naive: 50-75 mg every 3-4 hours as needed; patients with prior opiate exposure may require higher initial doses; usual dosage range: 50-150 mg every 2-4 hours as needed

Preoperatively: 50-100 mg given 30-90 minutes before the beginning of anesthesia

Slow I.V.: Initial: 5-10 mg every 5 minutes as needed

Patient-controlled analgesia (PCA): Usual concentration: 10 mg/mL

Initial dose: 10 mg

Demand dose: 1-5 mg (manufacturer recommendations); range 5-25 mg (American Pain Society, 1999).

Lockout interval: 5-10 minutes

Elderly:

Oral: 50 mg every 4 hours

I.M.: 25 mg every 4 hours

Dosing adjustment in renal impairment: Avoid repeated administration of meperidine in renal dysfunction:

Clcr 10-50 mL/minute: Administer at 75% of normal dose

Clcr<10 mL/minute: Administer at 50% of normal dose

Dosing adjustment/comments in hepatic disease: Increased narcotic effect in cirrhosis; reduction in dose more important for oral than I.V. route

Administration:

Monitoring Parameters:

Reference Range:

Test Interactions:

Patient Education:

Anesthesia and Critical Care Concerns/Other Considerations:

Dental Health: Effects on Dental Treatment:

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

Dental Comment:

Mental Health: Effects on Mental Status:

Mental Health: Effects on Psychiatric Treatment:

Oncology: Vesicant:

Dosage Forms:

Injection, solution, as hydrochloride [ampul]: 25 mg/0.5 mL (0.5 mL); 25 mg/mL (1 mL); 50 mg/mL (1 mL, 1.5 mL, 2 mL); 75 mg/mL (1 mL); 100 mg/mL (1 mL)

Injection, solution, as hydrochloride [prefilled syringe]: 25 mg/mL (1 mL); 50 mg/mL (1 mL); 75 mg/mL (1 mL); 100 mg/mL (1 mL)

Injection, solution, as hydrochloride [for PCA pump]: 10 mg/mL (30 mL, 50 mL, 60 mL)

Injection, solution, as hydrochloride [vial]: 25 mg/mL (1 mL); 50 mg/mL (1 mL, 30 mL); 75 mg/mL (1 mL); 100 mg/mL (1 mL, 20 mL) [may contain sodium metabisulfite]

Syrup, as hydrochloride: 50 mg/5 mL (500 mL) [contains sodium benzoate]

Demerol®: 50 mg/5 mL (480 mL) [contains benzoic acid; banana flavor]

Tablet, as hydrochloride (Demerol®, Meperitab®): 50 mg, 100 mg

International Brand Names: