A-Z Drug Facts > Meperidine Hydrochloride

Meperidine Hydrochloride

Pronouncation: (meh-PEHR-ih-deen HIGH-droe-KLOR-ide)
Class: Opioid analgesic

Trade Names:
Demerol
- Tablets 50 mg
- Tablets 100 mg
- Syrup 50 mg/5 mL
- Injection 25 mg/mL
- Injection 50 mg/mL
- Injection 75 mg/mL
- Injection 100 mg/mL

Pharmacology

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Relieves pain by stimulating opiate receptors in CNS; also causes respiratory depression, peripheral vasodilation, inhibition of intestinal peristalsis, sphincter of Oddi spasm, stimulation of chemoreceptors that cause vomiting and increased bladder tone.

Pharmacokinetics

Distribution

Meperidine protein binding is high.

Elimination

The primary route for excretion is renal. The t _½ is 3 to 4 h.

Onset

Onset is 10 to 45 min.

Peak

The times to peak effect are 3 to 50 min (IM/Subcutaneous), 60 to 90 min (oral), and 5 to 7 min (IV).

Duration

Duration is 2 to 4 h.

Indications and Usage

Oral and parenteral

Relief of moderate to severe pain.

Parenteral

Preoperative sedation; support of anesthesia; obstetrical analgesia.

Contraindications

Upper airway obstruction; acute asthma; diarrhea due to poisoning or toxins; patients who are receiving or have received MAOI within last 14 days.

Dosage and Administration

Pain
Adults

IM/Subcutaneous/PO 50 to 150 mg every 3 to 4 h as needed. If IV administration is required, reduce dose and administer slowly.

Children

IM/Subcutaneous/PO 1 to 1.8 mg/kg (up to adult dose) every 3 to 4 h as needed.

Preoperative Sedation
Adults

IM/Subcutaneous 50 to 100 mg 30 to 90 min before anesthetic.

Children

IM/Subcutaneous 1 to 2 mg/kg (0.5 to 1 mg/lb), up to adult dose, 30 to 90 min before beginning anesthesia.

Support of Anesthesia
Adults

IV Repeated doses diluted to 10 mg/mL by slow injection or by continuous infusion diluted to 1 mg/mL.

Obstetrical Analgesia
Adults

IM/Subcutaneous 50 to 100 mg every 1 to 3 h as needed when pains become regular.

Storage/Stability

Store at room temperature (59° to 86°F) in tightly closed, light-resistant container.

Drug Interactions

CNS depressants (eg, tranquilizers, sedatives, alcohol)

Additive CNS depression.

Cimetidine

Monitor for increased respiratory and CNS depression.

Hydantoins

Hydantoins may decrease the pharmacologic effects of meperidine, possibly because of increased hepatic metabolism of the narcotic.

MAOIs, furazolidone

Potentially fatal reactions can occur if meperidine is used in patients within 14 days of receiving MAOI or furazolidone.

Phenothiazines

Excessive sedation and hypotension.

Incompatibility

Do not co-infuse with solutions of soluble barbiturates, aminophylline, heparin, morphine, methicillin, phenytoin, sodium bicarbonate, iodine, sulfadiazine and sulfisoxazole.

Laboratory Test Interactions

Increased amylase and lipase may occur up to 24 h after dose.

Adverse Reactions

Cardiovascular

Hypotension; orthostatic hypotension; bradycardia; tachycardia.

CNS

Lightheadedness; dizziness; sedation; disorientation; incoordination; seizures.

Dermatologic

Sweating; pruritus; urticaria.

GI

Nausea; vomiting; constipation; abdominal pain.

Genitourinary

Urinary retention or hesitancy.

Respiratory

Respiratory depression; laryngospasm; depression of cough reflex.

Precautions

Pregnancy

Pregnancy category undetermined. Safety not established.

Lactation

Excreted in breast milk.

Renal Function

Dosage reduction may be necessary in patients with renal function impairment.

Hepatic Function

Dosage reduction may be necessary in patients with hepatic function impairment.

Special Risk Patients

Use with caution in patients with myxedema, acute alcoholism, acute abdominal conditions, ulcerative colitis, decreased respiratory reserve, head injury or increased intracranial pressure, hypoxia, supraventricular tachycardia, depleted blood volume, circulatory shock or renal function impairment.

Sulfite Sensitivity

Some parenteral products contain sulfites; may cause allergic-type reactions in susceptible individuals.

Drug dependence

Tolerance and psychological and physical dependence may occur with chronic use.

Neurotoxicity

Can cause dysphoria, hallucinations and seizures in patients with renal function impairment or with chronic high-dose therapy.

Overdosage

Symptoms

Miosis, respiratory and CNS depression, circulatory collapse, seizures, cardiopulmonary arrest, death.

Patient Information

• Instruct patient that if dose is missed, it should be taken as soon as possible unless close to time of next dose. Do not double up doses.
• If medication is given long term, explain that dosage will be tapered gradually before stopping to prevent withdrawal symptoms.
• Instruct patient not to wait until pain level is high to self-medicate because drug will not be as effective.
• Encourage increased fluid intake and moderate exercise to prevent constipation. Stool softeners or fiber laxative may also be used.
• Advise patient to use humidifier to liquefy secretions. Teach deep breathing exercises.
• Instruct patient to avoid sudden position changes to avoid orthostatic hypotension.
• Tell patient to avoid intake of alcoholic beverages or other CNS depressants (eg, sleeping pills, antihistamines).
• Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.

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