Meperidine

DEA Class; Rx

Common Brand Names; Demerol, pethidine

Phenylpiperidine opiate agonist
Used for relief of moderate to severe acute pain, postoperative shivering, and chills due to amphotericin B
May cause seizures with high or repeated doses, especially in patients with renal impairment

Hypersensitivity to drug or component of the formulation

Acute or severe bronchial asthma in an unmonitored setting or in absence of resuscitative equipment

Significant respiratory depression

Known or suspected gastrointestinal obstruction, including paralytic ileus

Within 14 days of taking MAO inhibitors; if linezolid or IV methylene blue (MAOIs) must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity; may resume 24 hr after last linezolid or methylene blue dose, or after 2 weeks of monitoring, whichever comes first

• Agitation
• Angina
• Bradycardia
• Cardiac arrest
• Coma
• Constipation
• Dizziness
• Dry mouth
• Dysphoria
• Euphoria
• Faintness
• Hypotension
• Mental clouding or depression
• Myocardial infarction
• Nausea
• Nervousness
• Palpitation
• Physical and psychological dependence
• Pruritus, urticaria
• QT-interval prolongation
• Respiratory arrest
• Respiratory/circulatory depression
• Restlessness
• Sedation
• Seizures
• Severe cardiac arrhythmias
• Shock
• ST-segment elevation
• Sweating, flushing, warmness of face/neck/upper thorax
• Syncope
• Tachycardia
• Urinary retention
• Visual disturbances
• Vomiting
• Weakness

Therapy exposes users to the risks of addiction, abuse and misuse; because extended-release products deliver opioid over extended period of time, there is a greater risk for overdose and death due to the larger amount of tramadol present; addiction can occur at recommended dosages and if drug is misused or abused; assess each patient’s risk for opioid addiction, abuse or misuse prior to prescribing therapy; risks are increased in patients with personal or family history of substance abuse (including drug or alcohol abuse or addiction) or mental illness (e.g., major depression); patients at risk may be prescribed opioids but use in such patients necessitates intensive counseling about risks and proper use along with intensive monitoring for signs of addiction, abuse and misuse; strategies to reduce these risks include prescribing drug in smallest appropriate quantity and advising patient on proper disposal of unused drug

Therapy may cause severe hypotension including orthostatic hypotension and syncope in ambulatory patients; there is increased risk in patients whose ability to maintain blood pressure has already been compromised by a reduced blood volume or concurrent administration of certain CNS depressant drugs (e.g., phenothiazines or general anesthetics); monitor patients for signs of hypotension after initiating or titrating dosage; in patients with circulatory shock, therapy may cause vasodilation that can further reduce cardiac output and blood pressure; avoid therapy in patients with circulatory shock

In patients who may be susceptible to intracranial effects of CO2 retention (e.g., those with evidence of increased intracranial pressure or brain tumors), therapy may reduce respiratory drive, and resultant CO2 retention can further increase intracranial pressure; monitor such patients for signs of sedation and respiratory depression, particularly when initiating therapy; opioids may obscure clinical course in a patient with a head injury; avoid the use in patients with impaired consciousness or coma

Pregnancy: Prolonged use of opioid analgesics during pregnancy for medical or nonmedical purposes can result in physical dependence in neonate and neonatal opioid withdrawal syndrome shortly after birth

Lactation: Meperidine appears in milk of nursing mothers receiving drug; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed infant or from underlying maternal condition