- Meperidine is an opioid agonist and a schedule II controlled substance, which may produce drug dependence of the morphine type and has the liability for being abused. Strongly consider this when prescribing or dispensing in situations where the physician/pharmacist is concerned about an increased risk of misuse, abuse or diversion
- Use very cautiously in patients who are concurrently receiving CNS depressants including sedatives or hypnotics, general anesthetics, phenothiazines, other tranquilizers, and alcohol because it may cause respiratory depression, hypotension, profound sedation, or coma
- Respiratory depressant effects of meperidine and secondary elevation of cerebrospinal fluid pressure may be markedly exaggerated in the presence of head injury, other intracranial lesions, or a preexisting increase in intracranial pressure
- Before IV administration of meperidine, facilities for assisted or controlled respiration and a narcotic antagonist should be readily available. When meperidine is given parenterally, especially intravenously, the patient should be lying down
- Meperidine should be injected very slowly when given intravenously in the form of a diluted solution, as rapid IV injection increases the incidence of severe respiratory depression, apnea, hypotension, peripheral circulatory collapse and cardiac arrest
- Use cautiously in patients having an acute asthmatic attack, chronic obstructive pulmonary disease/cor pulmonale, decreased respiratory reserve, preexisting respiratory depression, hypoxia/hypercapnia, atrial flutter and other supraventricular tachycardias. Usual therapeutic doses of meperidine may decrease respiratory drive while simultaneously increasing airway resistance to the point of apnea in this population
- Patients with depleted blood volume and those using concurrent administration of drugs such as phenothiazines or certain anesthetics may be prone to severe hypotension
- Advise patients not to perform any hazardous tasks such as driving a car or operating machinery after consuming this drug as it may impair their mental and/or physical abilities. Orthostatic hypotension may result in ambulatory patients during therapy
- Avoid using meperidine in pregnant women prior to the labor period
- Meperidine crosses the placental barrier and may produce depression of respiration and psychophysiologic functions in the newborn when used as an obstetrical analgesic
- Convulsions may be aggravated with the use of meperidine in patients with convulsive disorders; if dosage is substantially increased above recommended levels, convulsions may result in individuals without a history of convulsive disorder
- Therapy may obscure the diagnosis or clinical course in patients with acute abdominal conditions
- Use with extreme caution in patients receiving concomitant use of other narcotic analgesics
Cautions: Use cautiously in
- Severe renal impairment
- Severe hepatic impairment
- CNS depression
- Seizure disorder
- Pulmonary impairment
- Hypotension
- Prostatic hypertrophy
- Urethral stricture
- Adrenal insufficiency
- Hypothyroidism
- Acute alcoholism
- Sickle cell anemia
- Addison’s disease
- Pheochromocytoma
- Delirium tremens
- Toxic psychosis
- Kyphoscoliosis with respiratory depression
- Neonates or infants
- Elderly or debilitated patients
- Prolonged use
Pregnancy Category:C
Breastfeeding: This drug is compatible and considered safe with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776). Intravenous meperidine during labor can interfere with nursing, and maternal use of meperidine during breastfeeding can sedate the infants. Patient-controlled epidural analgesia postpartum appears to be free from these effects. Other agents are preferred for oral, intravenous or intramuscular use, especially while nursing a newborn or preterm infant, although a single dose for anesthesia or conscious sedation usually does not cause problems in older breastfed infants. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 28 April 2011).
US Trade Name(s)
US Availability
meperidine (generic)
- INJ: 25 mg/mL
- INJ: 50 mg/mL
- INJ: 75 mg/mL
- INJ: 100 mg/mL
meperidine preservative free
Demerol
- INJ: 25 mg/mL
- INJ: 50 mg/mL
- INJ: 75 mg/mL
- INJ: 100 mg/mL
Canadian Trade Name(s)
Canadian Availability
meperidine (generic)
- INJ: 10 mg/mL
- INJ: 25 mg/mL
- INJ: 50 mg/mL
- INJ: 75 mg/mL
- INJ: 100 mg/mL
Demerol
- INJ: 50 mg/mL
- INJ: 75 mg/mL
- INJ: 100 mg/mL
Pethidine
UK Trade Name(s)
UK Availability
pethidine (generic)
- INJ: 50 mg/mL (1 mL, 2 mL amp)
Australian Trade Name(s)
Australian Availability
pethidine (generic)
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