Generic Name: Meperidine Hydrochloride
Class: Opiate Agonists
VA Class: CN101
CAS Number: 50-13-5

Introduction

Opiate agonist; a synthetic phenylpiperidine derivative.b

Uses for Demerol

Acute Pain

A strong analgesic used in the relief of moderate to severe pain.b

Usually, temporary relief of moderate to severe pain such as that associated with acute and some chronic medical disorders including renal or biliary colic, acute trauma, postoperative pain, and cancer.e

Used to provide analgesia during diagnostic and orthopedic procedures and during labor.246 e

For preoperative sedation and as a supplement to anesthesia.e

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Around-the-clock dosing of analgesics may be considered in the initial stages of acute pain to avoid wide swings in pain and sedation often associated with as-needed dosing regimens.e

Although commonly used for acute pain relief, use as first-line opiate therapy is discouraged because of central excitatory toxicity of metabolite (normeperidine).247 245

Because of extensive first-pass metabolism in the liver to normeperidine, the risk of excitatory toxicity is increased with oral administration of meperidine; therefore, oral therapy is discouraged.246 247 245

Has been used to relieve the pain of MI, although probably not as effective as morphine sulfate.b

Chronic Pain

Use for chronic pain is discouraged because of short duration of effect and risk of accumulation of normeperidine metabolite and resultant central excitatory toxicity with repeated or large doses.e 248

Surgery

Used parenterally for preoperative sedation and as a supplement to anesthesia.b

Pulmonary Edema

Used in patients with acute pulmonary edema for its cardiovascular effects and to allay anxiety.b

Do not use in the treatment of pulmonary edema resulting from a chemical respiratory irritant.b

Demerol Dosage and Administration

General

  • Give the smallest effective dose and as infrequently as possible to minimize the development of tolerance and physical dependence.b

  • Reduced dosage is indicated initially in poor-risk patients, in geriatric and very young patients, in patients with renal (particularly) or hepatic impairment, and in patients receiving other CNS depressants.b 246 247 245

  • Reduce meperidine dose by 25–50% when used in conjunction with other CNS depressants (e.g., phenothiazines, other tranquilizers); dosage adjustment for the concomitantly administered drug also may be necessary.b

  • Orally, 300 mg is approximately equianalgesic with 30 mg morphine sulfate.c 245 248 Parenterally, 75–100 mg is approximately equianalgesic with 10 mg morphine sulfate.c 245 248 (For specific patient dosages, see dosage recommendations in Dosage and also see Prescribing Limits under Dosage and Administration.)

  • Generally limit to short-term use (a few days) because of risk of accumulation of toxic normeperidine metabolite with repeated or large doses.e 247 245 248

Administration

Administer orally; by sub-Q, IM, or slow IV injection; or by slow, continuous IV infusion.b

Oral Administration

Least effective when given orally.b 246 247 245 Higher dosages may be necessary for pain relief, but the risk of toxicity from metabolite normeperidine is increased.247 248

Oral therapy is discouraged because of extensive first-pass metabolism in the liver and resultant increased formation of the toxic metabolite (normeperidine).246 247 245 248

Dilution

Dilute each dose of oral solution in ½ glassful of water, since undiluted solution may produce slight topical anesthesia on mucous membranes.b

IV Administration

For solution and drug compatibility information, see Compatibility under Stability.

Administer by direct IV injection, IV infusion, or IV via a controlled-delivery device for patient-controlled analgesia (PCA).b c 246

If IV administration is required, decrease dosage and administer injections very slowly, preferably as a 10-mg/mL injection.b HID

Alternatively, may use the commercially available injection containing 10 mg/mL intended for use with a compatible infusion device (does not require further dilution); this 10-mg/mL injection is for single use only, and unused portions should be discarded appropriately.b

When given parenterally, especially by the IV route, the patient should be lying down.b

During and immediately following IV administration, an opiate antagonist and facilities for administration of oxygen and control of respiration should be available.b

Dilution

May dilute in a compatible IV solution for infusion, usually to a concentration of 1 mg/mL.b HID (See Solution Compatibility under Compatibility.)

Rate of Administration

Direct IV injection: Usually, very slowly, preferably as a 10-mg/mL injection.246 HID

IV injection for PCA: Self-administered intermittently as needed (“prn”) via controlled-delivery device, with usual lockout intervals (minimum time between self-administered doses programmed into device) of 6–12 minutes.246

IV infusion, adults: Usually, 15–35 mg/hour.b

IM Administration

Inject into a large muscle mass, taking care to avoid nerve trunks.b

IM injection is discouraged for any analgesic (e.g., the injection itself is painful, delayed onset).246 247 248

When repeat parenteral doses are necessary and IV therapy is not used, IM is preferred over sub-Q administration because of occurrence of local tissue irritation and induration following sub-Q injection.b

Epidural Administration

Preservative-free injections have been injected or infused epidurally; specialized techniques are required for administration of the drug by this route, and such administration should be performed only by qualified individuals familiar with the techniques of administration, dosages, and special patient management problems associated with epidural meperidine hydrochloride administration.b

Dosage

Pediatric Patients

Some experts discourage use in children.245

Usual Dosage
Oral, IM, or Sub-Q

May receive 1.1–1.8 mg/kg (up to adult dose) orally, IM, or sub-Q every 3–4 hours as needed.b c 246

Alternatively, 175 mg/m2 daily in 6 divided doses orally, IM, or sub-Q.b

Single pediatric doses should not exceed 100 mg.b

IV

Do not use for PCA when analgesic consumption is expected to be high; risk of CNS excitatory toxicity from normeperidine.247

PCA (usually IV) via controlled-delivery device: Loading doses of 0.5–1.5 mg/kg, preferably titrated by clinician or nurse at bedside.246

PCA (usually IV) via controlled-delivery device: Maintenance doses (administered intermittently) of 0.1–0.2 mg/kg, self-administered usually no more frequently than every 6–12 minutes as a device-programmed lockout period.246

Preoperative Dosage
IM or Sub-Q

May receive 1–2.2 mg/kg (maximum up to the adult dose) IM or sub-Q 30–90 minutes before the beginning of anesthesia.b

Adjunct to Anesthesia
IV Injection or IV Infusion

May be given by repeated slow IV injections of a dilute solution (e.g., containing 10 mg/mL) or by continuous IV infusion of a more dilute solution (e.g., containing 1 mg/mL).b

Adults

Usual Dosage
Oral, IM, or Sub-Q

Usually, 50–150 mg every 3–4 hours as needed.b c 246

IV infusion

Usually, 15–35 mg/hour.b

IV

Do not use for PCA when analgesic consumption is expected to be high; risk of CNS excitatory toxicity from normeperidine.247

PCA (usually IV) via controlled-delivery device: Loading doses of 12.5–25 mg every 10 minutes, preferably titrated by clinician or nurse at bedside, up to 50–125 mg total.246

PCA (usually IV) via controlled-delivery device: Maintenance doses (self-administered intermittently) of 5–10 mg, self-administered usually no more frequently than every 6–12 minutes as a device-programmed lockout period.246

Preoperative Dosage
IM or Sub-Q

Usually, 50–100 mg IM or sub-Q 30–90 minutes before the beginning of anesthesia.b

Adjunct to Anesthesia
IV Injection or IV Infusion

May be given by repeated slow IV injections of a dilute solution (e.g., containing 10 mg/mL) or by continuous IV infusion of a more dilute solution (e.g., containing 1 mg/mL).b

Analgesia during Labor
IM or Sub-Q

50–100 mg when labor pains become regular; repeat at 1- to 3-hour intervals as needed.b

Prescribing Limits

Pediatric Patients

Oral, IM, or Sub-Q

Single pediatric doses should not exceed 100 mg.b

Adults

Oral, IV, IM, or Sub-Q

Increased risk of toxicity from the active metabolite, normeperidine, when given for >48 hours or in total dosages exceeding 600 mg/24 hours.245 (See Elimination under Pharmacokinetics.)

Special Populations

Hepatic Impairment

Adjustment in the dose, frequency, and/or duration of therapy may be necessary because accumulation of the drug and/or its toxic metabolite, normeperidine, can occur.200 204 205 206 207 208 209 210 211 212 213

Certain adverse effects secondary to CNS stimulation (e.g., seizures, agitation, irritability, nervousness, tremors, twitches, myoclonus) have been attributed to accumulation of normeperidine.200 201 204 205 206 209 210 211 240

Oral bioavailability may be increased substantially in these patients.212 213 (See Pharmacokinetics.)

Renal Impairment

Generally avoid in renal impairment, particularly repeated or high doses.246 247 245

If used, adjustment in the dose, frequency, and/or duration of meperidine therapy is likely to be necessary because accumulation of the drug and/or its toxic metabolite, normeperidine, can occur.200 204 205 206 207 208 209 210 211 212 213

Certain adverse effects secondary to CNS stimulation (e.g., seizures, agitation, irritability, nervousness, tremors, twitches, myoclonus) have been attributed to accumulation of normeperidine.200 201 204 205 206 209 210 211 240

End-stage Renal Failure

Avoid because of the risk of accumulation of the toxic metabolite, normeperidine.200 205 207 208 211 220

Cautions for Demerol

Contraindications

  • Patients receiving MAO inhibitors.b e 244

  • Known hypersensitivity to meperidine or any ingredient in the respective formulation.244

Warnings/Precautions

Warnings

Shares the toxic potentials of the opiate agonists; observe the usual precautions of opiate agonist therapy.e

Serotonin Syndrome

Serotonin syndrome may occur in patients receiving MAO inhibitors in conjunction with other serotonergic drugs, including meperidine.

Concomitant use with an MAO inhibitor has resulted in excitatory effects (e.g., agitation, bizarre behavior, headache, hypertension, hypotension, rigidity, seizures, hyperpyrexia, coma) associated with serotonin syndrome.

Concomitant Use of Other CNS Depressants

Additive depressant effects may occur with concomitant use of other CNS depressants including other opiates, sedatives or hypnotics, general anesthetics, phenothiazines, tranquilizers, skeletal muscle relaxants, sedating antihistamines, and alcohol.e 244

When such combined therapy is contemplated, the dose of one or both agents should be reduced.b

Respiratory Depression

Causes dose-related respiratory depression.e 244

Respiratory depression is most common in geriatric or debilitated patients, or in conditions accompanied by hypoxia or hypercapnia; even moderate therapeutic opiate dosages may dangerously decrease pulmonary ventilation.e 244

Use with extreme caution, if at all, in anoxia, hypercapnia, respiratory depression, or in those who are especially prone to respiratory depression such as comatose patients or those with head injury, brain tumor, or elevated CSF pressure.e

Also use with extreme caution, if at all, in cor pulmonale, acute asthma exacerbation, or COPD and in others with substantially decreased respiratory reserve as in emphysema, hypoxia, hypercapnia, kyphoscoliosis, or severe obesity.e 244

Head Injury and Increased Intracranial Pressure

Respiratory depression effects and ability of opiates to increase CSF pressure may be markedly exaggerated in patients with head injury, other intracranial lesions, or preexisting elevation in intracranial pressure; opiate effects may produce cerebral hypoxia and obscure clinical course of patients with head injuries.244 Use with extreme caution, if at all.244

May interfere with evaluation of CNS function, and respiratory depression produced by the drug may produce cerebral hypoxia and elevated CSF pressure not caused by the injury itself.e 246

Ambulatory Patients

Performance of activities requiring mental alertness and physical coordination may be impaired (e.g., operating a motor vehicle or machinery).244

Hypotension

May cause severe hypotension postoperatively or when ability to maintain blood pressure is compromised (e.g., depleted blood volume, concurrent phenothiazine or general anesthetic use).244

May produce orthostatic hypotension in ambulatory patients.244

IM injection

Inadvertent IM injection into or near nerve trunks can result in sensory-motor paralysis, which may or may not be transient.b

Dependence

Physical and psychic dependence and tolerance may develop with repeated administration, and abuse potential exists; use with caution.e

Sensitivity Reactions

Sulfite Sensitivity

Some commercially available formulations contain sodium metabisulfite, a sulfite that may cause allergic-type reactions, including anaphylaxis and life-threatening or less severe asthmatic episodes, in certain susceptible individuals.b

Overall prevalence of sulfite sensitivity in the general population is unknown but probably low; such sensitivity appears to occur more frequently in asthmatic than in nonasthmatic individuals.b

General Precautions

Toxic Psychosis and Special Populations

Care should be exercised and the initial dosage of the opiate agonist should be reduced in patients with toxic psychosis and in geriatric or debilitated patients.e

Cardiac Arrhythmias

May increase ventricular response rate through a vagolytic action, therefore use with caution in patients with atrial flutter and other supraventricular tachycardias.b 244

Acute Abdominal Conditions

May obscure diagnosis or clinical course of patients with acute abdominal conditions.244

Seizure Risk

May aggravate preexisting seizure disorders.

Accumulation of toxic normeperidine metabolite can stimulate the CNS and precipitate seizures in patients without a preexisting seizure disorder.246 247 245 248

Normeperidine Accumulation

Use with caution in patients at risk for accumulation of normeperidine (e.g., those with renal or hepatic impairment) and during prolonged therapy and/or with high dosages in other patients (e.g., those with sickle cell anemia or CNS disease, burn patients, cancer patients) at risk for neurotoxic effects of the metabolite.200 204 205 206 207 208 209 210 211 212 213 220 240 245

Observe these patients closely for potential manifestations of CNS stimulation (e.g., seizures, agitation, irritability, nervousness, tremors, twitches, myoclonus) associated with accumulation of the metabolite.246 247 248 200 204 205 206 208 209 210 211 220 240

Specific Populations

Pregnancy

Category C.PDH

Lactation

Distributed into milk.246 244 Discontinue nursing or the drug.244

Pediatric Use

Should not be given to infants <6 months of age;PDH neonatal elimination is greatly reduced.246

Some experts discourage use in children of any age.245

Geriatric Use

Elimination is slower in geriatric patients than in younger patients.244

Geriatric patients, especially those with decreased renal and hepatic function, may be at greater risk for adverse CNS effects secondary to accumulation of the toxic metabolite normeperidine.242 243 244

Use with caution in geriatric patients, taking into account the potential risks and benefits to the patient, and dosage adjustment should be considered.246 242 243 244

Hepatic Impairment

Adjustment in the dose, frequency, and/or duration of therapy may be necessary because accumulation of the drug and/or its toxic metabolite, normeperidine, can occur.200 204 205 206 207 208 209 210 211 212 213 (See Hepatic Impairment under Dosage and Administration.)

Renal Impairment

Generally avoid in renal impairment, particularly repeated or high doses.246 247 245 (See Renal Impairment under Dosage and Administration.)

Common Adverse Effects

Adverse CNS effects include dizziness, visual disturbances, mental clouding or depression, sedation, coma, euphoria, dysphoria, weakness, faintness, agitation, restlessness, nervousness, seizures, and, rarely, delirium and insomnia.e

Adverse GI effects of opiate agonists include nausea, vomiting, and constipation.e

Opiate agonists may interfere with evaluation of CNS function, especially relative to consciousness levels, pupillary changes, and respiratory depression, thereby masking the patient’s clinical course.e

May increase the risk of water intoxication in postoperative patients because of stimulation of the release of vasopressin.e

Interactions for Demerol

Specific Drugs

Drug

Interaction

Comments

Amphetamines

Dextroamphetamine may enhance opiate agonist analgesiae

May be used to therapeutic advantage

Anticoagulants

Opiate agonists have been reported to potentiate the anticoagulant activity of coumarin anticoagulantse

Antidepressants, tricyclic

May potentiate the effects of tricyclic antidepressants e

Use concomitantly with caution; dosage adjustment may be necessarye

CNS depressants

May potentiate the effects of other CNS depressants including other opiates, general anesthetics, tranquilizers, sedatives and hypnotics, and alcohole

Use with great caution and in reduced dosage when used in conjunction with such drugs; some tranquilizers, especially phenothiazines, may antagonize opiate agonist analgesiae

Diuretics

Opiate agonists may decrease the effects of diuretics in patients with congestive heart failuree

Estrogens or estrogen-progestin combinations (oral contraceptives)

Oral contraceptives or estrogens may inhibit meperidine metabolism; clinical importance of this inhibition on analgesic effectiveness of meperidine has not been determinedb

Isoniazid

Concomitant use may aggravate the adverse effects of isoniazidb

MAO inhibitors

Therapeutic doses of meperidine concomitantly with an MAO inhibitor have produced coma, severe respiratory depression, cyanosis, and hypotension resembling the typical syndrome of acute opiate overdosage; these adverse effects may be associated with preexisting hyperphenylalaninemiab

Also, hyperexcitability and hypertension with concomitant useb

Meperidine is contraindicated in patients who have received an MAO inhibitor during the previous 14 daysb e

Skeletal muscle relaxants

May enhance the neuromuscular blocking action of skeletal muscle relaxantse

Demerol Pharmacokinetics

Absorption

Bioavailability

Oral: Undergoes extensive first-pass metabolism in the liver, with approximately 50–60% of a dose reaching systemic circulation unchanged.246 246 207 212 213 214

Oral: Bioavailability increases to approximately 80–90% in patients with hepatic impairment.212 213

Less than half as effective when given orally as when given parenterally.b 247

IM: Approximately 80–85% of a dose of the drug is absorbed within 6 hours after intragluteal injection.217

Onset

Oral, peak analgesia: Within 1 hour and declines gradually over 2–4 hours.b

Sub-Q, peak analgesia: In about 40–60.b

IM, peak analgesia: In about 30–50 minutes.b

Duration

Sub-Q or IM: Analgesia is maintained for 2–4 hours.b

Plasma Concentrations

Oral, peak: About 1 hour.246

IM, peak: Within 5–15 minutes..246

Distribution

Extent

Crosses the placenta; may accumulate in fetus.246 207 218

Distributes into breast milk.b 244

Plasma Protein Binding

Approximately 60–80%;246 212 principally albumin and α1-acid glycoprotein.246 212

Elimination

Metabolism

Principally in the liver.b 246

Normeperidine is the active metabolite and exhibits about half the analgesic potency of meperidine but twice the CNS stimulant (e.g., seizure-inducing) potency.200 201 202 203 204 205 206 207 208 209 210 211

Various toxic effects secondary to CNS stimulation (e.g., seizures, agitation, irritability, nervousness, tremors, twitches, myoclonus) have been attributed to accumulation of normeperidine.200 201 204 205 206 209 210 211 240

Elimination Route

Excreted in urine as metabolites and unchanged drug.b 246

Acidifying the urine enhances excretion of the unchanged drug and normeperidine.b

Half-life

Distribution phase half-life, meperidine: 2–11 minutes207 215 219

Terminal elimination half-life, meperidine: 3–5 hours.246 200 204 205 207 213 214 215 216 217 219

Terminal elimination half-life, normeperidine: Approximately 8–21 hours.246 200 204 205 207 208 210

Special Populations

Elimination half-life in hepatic dysfunction, meperidine: Prolonged.207

Cirrhosis207 213 215 or active viral hepatitis:207 216 Averages about 7–11 hours.b

Terminal elimination half-life in renal impairment, normeperidine: May be prolonged (e.g., 30–40 hours).200 204 205 207 208 210 211

Renal or hepatic impairment: Accumulation of normeperidine may occur with repeated, high doses of the drug.200 204 205 206 207 212 213 240

Stability

Storage

Protect from light and store at a temperature <40°C.b

Oral

Tablets

Well-closed containersb at 25°C (may be exposed to 15–30°C).244

Oral Solution

Tight containersb at 25°C (may be exposed to 15–30°C).244

Avoid freezing.b

Parenteral

Injection

15–25°C.b

Avoid freezing.b

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Solution CompatibilityHID

Compatible

Dextrose–Ringer’s injection combinations

Dextrose–Ringer’s injection, lactated, combinations

Dextrose–saline combinations

Dextrose 2.5, 5, or 10% in water

Ionosol products

Ringer’s injection

Ringer’s injection, lactated

Sodium chloride 0.18, 0.45, or 0.9%

Sodium lactate (1/6) M

Drug Compatibility
Admixture CompatibilityHID

Compatible

Cefazolin sodium

Clonidine HCl

Dobutamine HCl

Metoclopramide HCl

Ondansetron HCl

Scopolamine HBr

Sodium bicarbonate

Succinylcholine chloride

Verapamil HCl

Incompatible

Furosemide

Y-Site CompatibilityHID

Compatible

Amifostine

Amikacin sulfate

Ampicillin sodium

Ampicillin sodium–sulbactam sodium

Anidulafungin

Aztreonam

Bivalirudin

Bumetanide

Caspofungin acetate

Cefazolin sodium

Cefotaxime sodium

Cefotetan disodium

Cefoxitin sodium

Ceftaroline fosamil

Ceftazidime

Ceftriaxone sodium

Cefuroxime sodium

Chloramphenicol sodium succinate

Cisatracurium besylate

Cladribine

Clindamycin phosphate

Co-trimoxazole

Dexamethasone sodium phosphate

Dexmedetomidine HCl

Digoxin

Diltiazem HCl

Diphenhydramine HCl

Dobutamine HCl

Docetaxel

Dopamine HCl

Doripenem

Doxycycline hyclate

Droperidol

Erythromycin lactobionate

Etoposide phosphate

Famotidine

Fenoldopam mesylate

Filgrastim

Fluconazole

Fludarabine phosphate

Gallium nitrate

Gemcitabine HCl

Gentamicin sulfate

Granisetron HCl

Heparin sodium

Hetastarch in lactated electrolyte injection (Hextend)

Hydrocortisone sodium succinate

Hydroxyethyl starch 130/0.4 in sodium chloride 0.9%

Insulin, regular

Labetalol HCl

Lidocaine HCl

Linezolid

Magnesium sulfate

Melphalan HCl

Methyldopate HCl

Methylprednisolone sodium succinate

Metoclopramide HCl

Metoprolol tartrate

Metronidazole

Ondansetron HCl

Oxacillin sodium

Oxaliplatin

Oxytocin

Paclitaxel

Palonosetron HCl

Pemetrexed disodium

Penicillin G potassium

Piperacillin sodium–tazobactam sodium

Potassium chloride

Propofol

Propranolol HCl

Ranitidine HCl

Remifentanil HCl

Sargramostim

Teniposide

Thiotepa

Ticarcillin disodium–clavulanate potassium

Tobramycin sulfate

Vancomycin HCl

Verapamil HCl

Vinorelbine tartrate

Incompatible

Allopurinol sodium

Amphotericin B cholesteryl sulfate complex

Doxorubicin HCl liposome injection

Idarubicin HCl

Imipenem–cilastatin sodium

Micafungin sodium

Variable

Acyclovir sodium

Furosemide

Nafcillin sodium

Actions

  • Opiate agonists alter perception of and emotional response to pain.246

  • Precise mechanism of action has not been fully elucidated; opiate agonists act at several CNS sites, involving several neurotransmitter systems to produce analgesia.246

  • Pain perception is altered in the spinal cord and higher CNS levels (e.g., substantia gelatinosa, spinal trigeminal nucleus, periaqueductal gray, periventricular gray, medullary raphe nuclei, hypothalamus).246

  • Opiate agonists do not alter the threshold or responsiveness of afferent nerve endings to noxious stimuli, nor peripheral nerve impulse conduction.246

  • Opiate agonists act at specific receptor binding sites in the CNS and other tissues; opiate receptors are concentrated in the limbic system, thalamus, striatum, hypothalamus, midbrain, and spinal cord.246

  • Agonist activity at the opiate μ- or κ-receptor can result in analgesia, miosis, and/or decreased body temperature.246

  • Agonist activity at the μ-receptor can also result in suppression of opiate withdrawal (and antagonist activity can result in precipitation of withdrawal).246

  • Respiratory depression may be mediated by μ-receptors, possibly μ2-receptors (which may be distinct from μ1-receptors involved in analgesia); κ- and δ-receptors may also be involved in respiratory depression.246

  • Equianalgesic doses of meperidine hydrochloride and morphine sulfate produce the same degree of respiratory depression.b

  • Sedative and euphoric effects of equianalgesic doses of meperidine may be greater than those of morphine but reports are conflicting.b

  • Causes little or no constipation and has antitussive activity only in analgesic doses.b

  • Exhibits some anticholinergic properties.e

  • Systemic administration: May cause corneal anesthesia which can abolish the corneal reflex.b

  • Topical application: Produces considerable local anesthesia, but meperidine is not utilized for local anesthesia because it also produces local irritation.b

  • Overdosage may produce mydriasis rather than miosis.e

  • Toxic effects may be excitatory.e

Advice to Patients

  • Potential for drug to impair mental alertness or physical coordination; avoid driving or operating machinery until effects on individual are known.244

  • Advise patients of risk of postural hypotension during ambulation.244

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses.

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.

  • Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Meperidine hydrochloride preparations are subject to control under the Federal Controlled Substances Act of 1970 as schedule II (C-II) drugs.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Meperidine Hydrochloride

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Solution

50 mg/5 mL*

Demerol Hydrochloride Syrup (C-II)

Sanofi-Aventis

Meperidine HCl Syrup (C-II)

Roxane

Tablets

50 mg*

Demerol Hydrochloride (C-II)

Sanofi-Aventis

100 mg*

Demerol Hydrochloride (C-II)

Sanofi-Aventis

Parenteral

Injection

25 mg/mL*

Demerol Hydrochloride (C-II; in Carpuject cartridges)

Hospira

Meperidine HCl Injection (C-II; in ampuls and Tubex)

Baxter

50 mg/mL*

Demerol Hydrochloride (C-II; in ampuls and Carpuject cartridges or in multiple-dose vials)

Hospira

Meperidine HCl Injection (C-II; with metacresol)

AstraZeneca

Meperidine HCl Injection (C-II; in ampuls and Tubex or in multiple-dose vials)

Baxter

75 mg/mL*

Demerol Hydrochloride (C-II; in Carpuject cartridges)

Hospira

Meperidine HCl Injection (C-II; in ampuls and Tubex)

Baxter

100 mg/mL*

Demerol Hydrochloride (C-II; in ampuls and Carpuject cartridges or in multiple-dose vials)

Hospira

Meperidine HCl Injection (C-II)

AstraZeneca

Meperidine HCl Injection (C-II; in ampuls and Tubex or in multiple-dose vials)

Baxter

Injection, for IV infusion via compatible infusion devices only

10 mg/mL (300 mg)*

Meperidine HCl Injection (C-II)

Hospira

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Demerol 100MG Tablets (SANOFI-AVENTIS U.S.): 20/$76.27 or 30/$104.83

Demerol 50MG Tablets (SANOFI-AVENTIS U.S.): 30/$55.07 or 90/$157.65

Meperidine HCl 100MG/ML Solution (WEST-WARD): 1/$33.99 or 3/$84.97

Meperidine HCl 100MG Tablets (TEVA PHARMACEUTICALS USA): 20/$26.66 or 30/$39.99

Meperidine HCl 50MG/5ML Solution (ROXANE): 500/$69.99 or 1500/$209.98

Meperidine HCl 50MG Tablets (TEVA PHARMACEUTICALS USA): 20/$19.99 or 30/$27.99

Meperitab 100MG Tablets (QUALITEST): 20/$24.99 or 30/$37.49

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions July 10, 2013. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

200. Szeto HH, Inturrisi CE, Houde R et al. Accumulation of normeperidine, an active metabolite of meperidine, in patients with renal failure or cancer. Ann Intern Med. 1977; 86:738-41. [PubMed 869353]

201. MacDonald AD, Woolfe G, Bergel F et al. Analgesic action of pethidine derivatives and related compounds. Br J Pharmacol. 1946; 1:4-14.

202. Miller JW, Anderson HH. The effect of N-demethylation on certain pharmacologic actions of morphine, codeine, and meperidine in the mouse. J Pharmacol Exp Ther. 1954; 112:191-6. [PubMed 13212628]

203. Deneau GA, Nakai K. The toxicity of meperidine in the monkey as influenced by its rate of absorption. Bull Drug Addict Narc. 1961; App. 6:2460-9.

204. Mauro VF, Bonfiglio MF, Spunt AL. Meperidine-induced seizure in a patient without renal dysfunction or sickle cell anemia. Clin Pharm. 1986; 5:837-9. [IDIS 221387] [PubMed 3780155]

205. Kaiko RF, Foley KM, Grabinski PY et al. Central nervous system excitatory effects of meperidine in cancer patients. Ann Neurol. 1983; 13:180-5. [IDIS 165923] [PubMed 6187275]

206. Goetting MG, Thirman MJ. Neurotoxicity of meperidine. Ann Emerg Med. 1985; 14:1007-9. [PubMed 4037466]

207. Mather LE, Meffin PJ. Clinical pharmacokinetics pethidine. Clin Pharmacokinet. 1978; 3:352-68. [IDIS 115500] [PubMed 359212]

208. Hochman MS. Meperidine-associated myoclonus and seizures in long-term hemodialysis patients. Ann Neurol. 1983; 14:593. [IDIS 178568] [PubMed 6418061]

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