meperidine

Contraindicated in:

Hypersensitivity
Hypersensitivity to bisulfites (some injectable products)
Recent (within 14 days) MAO inhibitor therapy
Severe respiratory impairment
OB: Labor and delivery
Lactation: Lactation.

Use Cautiously in:

Head trauma
↑ intracranial pressure
Severe renal or hepatic impairment
Acute asthma attack, COPD, hypoxia, or hypercapnea
Hypothyroidism
Adrenal insufficiency
Alcoholism
Debilitated patients (dose ↓ suggested)
Undiagnosed abdominal pain or prostatic hyperplasia
Extensive burns
High-dose or prolonged therapy (>600 mg/day or >2 days; ↑ risk of CNS stimulation and seizures due to accumulation of normeperidine)
Sickle cell anemia (may require ↓ initial doses)
OB: Avoid chronic use during pregnancy as can result in neonatal opioid withdrawal syndrome
Pedi: Syrup contains benzyl alcohol, which can cause "gasping syndrome" in neonates. Children have ↑ risk of seizures due to accumulation of normeperidine
Geri: Appears on Beers list. ↑ risk of delirium in older adults. Avoid use in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension, bradycardia.

Derm: flushing, sweating.

EENT: blurred vision, diplopia, miosis.

Endo: adrenal insufficiency.

GI: constipation, nausea, vomiting.

GU: urinary retention.

Neuro: confusion, sedation, dysphoria, euphoria, floating feeling, hallucinations, headache, SEIZURES, unusual dreams.

Resp: RESPIRATORY DEPRESSION (INCLUDING CENTRAL SLEEP APNEA OR SLEEP-RELATED HYPOXEMIA).

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS), physical dependence, psychological dependence, tolerance.

Interactions ⬆ ⬇

Drug-Drug:

Do not use in patients receiving MAO inhibitors or procarbazine (may cause fatal reaction—contraindicated within 14 days of MAO inhibitor therapy).
Use with benzodiazepines or other CNS depressants including other opioids, non-benzodiazepine sedative/hypnotics, anxiolytics, general anesthetics, muscle relaxants, antipsychotics, and alcohol may cause profound sedation, respiratory depression, coma, and death; reserve concurrent use for when alternative treatment options are inadequate.
Administration of mixed agonist/antagonist analgesics, including nalbuphine or butorphanol or partial agonist analgesics, including buprenorphine, may ↓ meperidine's analgesic effects and/or precipitate opioid withdrawal in physically dependent patients.
Concurrent use of CYP3A4 inhibitors including ritonavir, ketoconazole, itraconazole, fluconazole, clarithromycin, erythromycin, nefazodone, diltiazem, verapamil, nelfinavir, and fosamprenavir ↑ levels and risk of opioid toxicity; careful monitoring during initiation, dose changes, or discontinuation of the inhibitor is recommended.
Concurrent use with CYP3A4 inducers including barbiturates, carbamazepine, efavirenz, corticosteroids, modafinil, nevirapine, oxcarbazepine, phenobarbital, phenytoin, rifabutin, or rifampin may ↓ levels and analgesia; if inducers are discontinued or dosage ↓, patients should be monitored for signs of opioid toxicity and necessary dose adjustments should be made.
Chlorpromazine and thioridazine may ↑ the risk of adverse reactions (concurrent use should be avoided).
May aggravate side effects of isoniazid.
Acyclovir may ↑ levels of meperidine and normeperidine.
Drugs that affect serotonergic neurotransmitter systems, including tricyclic antidepressants, SSRIs, SNRIs, MAO inhibitors, TCAs, tramadol, trazodone, mirtazapine, 5–HT₃ receptor antagonists, linezolid, methylene blue, and triptans ↑ risk of serotonin syndrome.

Drug-Natural Products:

Concomitant use of kava-kava, valerian, or chamomile can ↓ CNS depression.
St. John's wort may ↑ serious side effects, concurrent use is not recommended.

Availability ⬆ ⬇

(Generic available)

Tablets: 50 mg; 100 mg;
Oral solution (banana flavor): 50 mg/5 mL;
Solution for injection : 25 mg/mL; 50 mg/mL; 75 mg/mL; 100 mg/mL;

Route/Dosage ⬆ ⬇

PO (Adults): Analgesia: 50–150 mg every 3–4 hr; may ↑ as needed (not to exceed 600 mg/24 hr).
IM, SC (Adults): Analgesia: 50–150 mg every 3–4 hr; may ↑ as needed (not to exceed 600 mg/24 hr). Analgesia during labor: 50–100 mg when contractions become regular; may repeat every 1–3 hr. Preoperative sedation: 50–100 mg 30–90 min before anesthesia.
PO (Children): Analgesia: 1.1–1.8 mg/kg every 3–4 hr (max = 100 mg/dose).
IM, SC (Children): Analgesia: 1.1–1.8 mg/kg every 3–4 hr (max = 100 mg/dose). Preoperative sedation: 1.1–2.2 mg/kg 30–90 min before anesthesia (not to exceed adult dose).
IV (Adults): 15–35 mg/hr as a continuous infusion; PCA: 10 mg initially; with a range of 1–5 mg/incremental dose, recommended lockout interval is 6–10 min (minimum 5 min).
IV (Children): Continuous infusion: 0.5–1 mg/kg loading dose followed by 0.3 mg/kg/hr, titrate to effect up to 0.5–0.7 mg/kg/hr.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli, while producing generalized CNS depression.

Therapeutic Effects:

Reduction in severity of pain.

Classifications ⬆ ⬇

Therapeutic Classification: opioid analgesics

Pharmacologic Classification: opioid agonists

Pharmacokinetics ⬆ ⬇

Absorption: 50% from the GI tract; well absorbed from IM sites. Oral doses are about half as effective as parenteral doses. IV administration results in complete bioavailability.

Distribution: Widely distributed to tissues.

Metabolism/Excretion: Mostly metabolized by the liver; some converted to normeperidine, which may accumulate and cause seizures. 5% excreted unchanged by the kidneys.

Half-life: Neonates: 12–39 hr; Infants 3–18 mo: 2.3 hr; Children 5–8 yr: 3 hr; Adults: 2.5–4 hr (↑ in impaired renal or hepatic function [7–11 hr]).

Contr. Subst. Schedule ⬆ ⬇

Time/Action Profile ⬆ ⬇

(analgesia)

ROUTE	ONSET	PEAK	DURATION
PO	15 min	60 min	2–4 hr
IM	10–15 min	30–50 min	2–4 hr
SUBQ	10–15 min	40–60 min	2–4 hr
IV	immediate	5–7 min	2–3 hr

Patient/Family Teaching ⬆ ⬇

Instruct patient on how and when to ask for and take pain medication.
REMS: Instruct patient to take meperidine as directed. If dose is less effective after a few wk, do not increase dose without consulting health care professional. Discuss safe use, risks, and proper storage and disposal of opioid analgesics with patients and caregivers with each Rx. The Patient Counseling Guide is available at OpioidAnalgesicREMSPCG. Pedi: Teach parents or caregivers how to accurately measure liquid medication and to use only the measuring device dispensed with the medication.
Instruct patient on how and when to ask for and take pain medication.
Advise patient that meperidine is a drug with known abuse potential. Protect it from theft, and never give to anyone other than the individual for whom it was prescribed. Store out of sight and reach of children, and in a location not accessible by others.
May cause drowsiness or dizziness. Advise patient to call for assistance when ambulating or smoking. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Advise patient that meperidine is a drug with known abuse potential. Protect it from theft, and never give to anyone other than the individual for whom it was prescribed. Store out of sight and reach of children, and in a location not accessible by others.
Educate patients and caregivers on how to recognize respiratory depression and emphasize the importance of calling 911 or getting emergency medical help right away in the event of a known or suspected overdose. Inform patients and caregivers about various ways to obtain naloxone as permitted by individual state naloxone dispensing and prescribing requirements or guidelines (by prescription, directly from a pharmacist, or as part of a community-based program).
Advise patient to change positions slowly to minimize orthostatic hypotension.
Instruct patient to avoid concurrent use of alcohol or other CNS depressants, may lead to overdose.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
Advise ambulatory patients that nausea and vomiting may be decreased by lying down.
Encourage patient to turn, cough, and breathe deeply every 2 hr to prevent atelectasis.
Rep: May cause fetal harm. Advise females with reproductive potential to notify health care professional if pregnancy is planned or suspected, and to avoid breastfeeding. Inform patient of potential for neonatal opioid withdrawal syndrome with prolonged use during pregnancy. Monitor neonate for signs and symptoms of withdrawal symptoms (irritability, hyperactivity and abnormal sleep pattern, high pitched cry, tremor, vomiting, diarrhea, and/or failure to gain weight); usually occur the first days after birth. Monitor infants exposed to meperidine through breast milk for excess sedation and respiratory depression. Chronic use may reduce fertility in females and males.

Pronunciation ⬆ ⬇

Code ⬆

NDC Code^*

0054- West-Ward Pharmaceuticals Corp.
0054-3545- Meperidine Hydrochloride 0054-3545-63- 500 mL in 1 BOTTLE (0054-3545-63)

0054- West-Ward Pharmaceuticals Corp.
0054-4595- Meperidine Hydrochloride 0054-4595-25- 100 TABLET in 1 BOTTLE (0054-4595-25)

0054- West-Ward Pharmaceuticals Corp.
0054-4596- Meperidine Hydrochloride 0054-4596-25- 100 TABLET in 1 BOTTLE (0054-4596-25)

0054- West-Ward Pharmaceuticals Corp.
0054-8595- Meperidine Hydrochloride 0054-8595-11- 1 BLISTER PACK in 1 BOX (0054-8595-11) > 25 TABLET in 1 BLISTER PACK

0409- Hospira, Inc.
0409-1176- DEMEROL 0409-1176-30- 10 CARTRIDGE in 1 CARTON (0409-1176-30) > 1 mL in 1 CARTRIDGE (0409-1176-03)

0409- Hospira, Inc.
0409-1178- DEMEROL 0409-1178-30- 10 CARTRIDGE in 1 CARTON (0409-1178-30) > 1 mL in 1 CARTRIDGE (0409-1178-03)

0409- Hospira, Inc.
0409-1179- DEMEROL 0409-1179-30- 10 CARTRIDGE in 1 CARTON (0409-1179-30) > 1 mL in 1 CARTRIDGE (0409-1179-03)

0409- Hospira, Inc.
0409-1180- DEMEROL 0409-1180-69- 10 CARTRIDGE in 1 CARTON (0409-1180-69) > 1 mL in 1 CARTRIDGE (0409-1180-59)

0409- Hospira, Inc.
0409-1181- DEMEROL 0409-1181-30- 1 VIAL, MULTI-DOSE in 1 CARTON (0409-1181-30) > 30 mL in 1 VIAL, MULTI-DOSE

0409- Hospira, Inc.
0409-1201- DEMEROL 0409-1201-20- 1 VIAL, MULTI-DOSE in 1 CARTON (0409-1201-20) > 20 mL in 1 VIAL, MULTI-DOSE

0409- Hospira, Inc.
0409-1203- DEMEROL 0409-1203-01- 25 AMPULE in 1 CARTON (0409-1203-01) >.5 mL in 1 AMPULE (0409-1203-11)

0409- Hospira, Inc.
0409-1253- DEMEROL 0409-1253-01- 25 AMPULE in 1 CARTON (0409-1253-01) > 1 mL in 1 AMPULE (0409-1253-11)

0409- Hospira, Inc.
0409-1254- DEMEROL 0409-1254-01- 25 AMPULE in 1 CARTON (0409-1254-01) > 1.5 mL in 1 AMPULE (0409-1254-11)

0409- Hospira, Inc.
0409-1255- DEMEROL 0409-1255-02- 25 AMPULE in 1 CARTON (0409-1255-02) > 2 mL in 1 AMPULE (0409-1255-12)

0409- Hospira, Inc.
0409-1256- DEMEROL 0409-1256-01- 25 AMPULE in 1 CARTON (0409-1256-01) > 1 mL in 1 AMPULE (0409-1256-11)

0555- Teva Pharmaceuticals USA, Inc.
0555-0381- Meperidine Hydrochloride 0555-0381-02- 100 TABLET in 1 BOTTLE (0555-0381-02)

0555- Teva Pharmaceuticals USA, Inc.
0555-0392- Meperidine Hydrochloride 0555-0392-02- 100 TABLET in 1 BOTTLE (0555-0392-02)

0641- West-Ward Pharmaceuticals Corp.
0641-6052- MEPERIDINE HYDROCHLORIDE 0641-6052-25- 25 VIAL in 1 CARTON (0641-6052-25) > 1 mL in 1 VIAL (0641-6052-01)

0641- West-Ward Pharmaceuticals Corp.
0641-6053- MEPERIDINE HYDROCHLORIDE 0641-6053-25- 25 VIAL in 1 CARTON (0641-6053-25) > 1 mL in 1 VIAL (0641-6053-01)

0641- West-Ward Pharmaceuticals Corp.
0641-6054- MEPERIDINE HYDROCHLORIDE 0641-6054-25- 25 VIAL in 1 CARTON (0641-6054-25) > 1 mL in 1 VIAL (0641-6054-01)

30698- Validus Pharmaceuticals LLC
30698-335- Demerol 30698-335-01- 100 TABLET in 1 BOTTLE, PLASTIC (30698-335-01)

30698- Validus Pharmaceuticals LLC
30698-337- Demerol 30698-337-01- 100 TABLET in 1 BOTTLE, PLASTIC (30698-337-01)

42806- EPIC PHARMA, LLC
42806-050- Meperidine Hydrochloride 42806-050-01- 100 TABLET in 1 BOTTLE (42806-050-01)

42806- EPIC PHARMA, LLC
42806-051- Meperidine Hydrochloride 42806-051-01- 100 TABLET in 1 BOTTLE (42806-051-01)

46672- Mikart, LLC
46672-829- meperidine hydrochloride 46672-829-10- 100 TABLET in 1 BOTTLE, PLASTIC (46672-829-10)

46672- Mikart, LLC
46672-829- meperidine hydrochloride 46672-829-50- 500 TABLET in 1 BOTTLE, PLASTIC (46672-829-50)

46672- Mikart, LLC
46672-830- meperidine hydrochloride 46672-830-10- 100 TABLET in 1 BOTTLE, PLASTIC (46672-830-10)

46672- Mikart, LLC
46672-831- meperidine hydrochloride 46672-831-10- 100 TABLET in 1 BOTTLE, PLASTIC (46672-831-10)

46672- Mikart, LLC
46672-831- meperidine hydrochloride 46672-831-50- 500 TABLET in 1 BOTTLE, PLASTIC (46672-831-50)

46672- Mikart, LLC
46672-832- meperidine hydrochloride 46672-832-10- 100 TABLET in 1 BOTTLE, PLASTIC (46672-832-10)

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Indications ⬇

Contraind./Precautions ⬆ ⬇