Demerol Side Effects

Generic Name: meperidine

Note: This page contains information about the side effects of meperidine. Some of the dosage forms included on this document may not apply to the brand name Demerol.

Not all side effects for Demerol may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to meperidine: oral solution, oral syrup, oral tablet

Other dosage forms:

In addition to its needed effects, some unwanted effects may be caused by meperidine (the active ingredient contained in Demerol). In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when taking meperidine:

Incidence not known
  • Blurred vision
  • chest pain or discomfort
  • cold, clammy skin
  • confusion
  • convulsion
  • cough
  • decrease in the frequency of urination
  • decrease in urine volume
  • difficult or troubled breathing
  • difficulty in passing urine (dribbling)
  • difficulty with swallowing
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • fainting
  • fast, slow, pounding, or irregular heartbeat or pulse
  • fast, weak pulse
  • feeling of warmth
  • hives
  • irregular, fast, slow, or shallow breathing
  • itching
  • lightheadedness, dizziness, or fainting
  • muscle twitching or jerking
  • painful urination
  • pale or blue lips, fingernails, or skin
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • redness of the face, neck, arms, and occasionally, upper chest
  • rhythmic movement of the muscles
  • shakiness in the legs, arms, hands, or feet
  • shortness of breath
  • skin rash
  • sweating
  • tightness in the chest
  • trembling or shaking of the hands or feet
  • unconsciousness
  • unusual tiredness or weakness
  • upper abdominal or stomach pain
  • very low blood pressure or pulse
  • very slow breathing
  • wheezing

If any of the following symptoms of overdose occur while taking meperidine, get emergency help immediately:

Symptoms of overdose
  • Bluish color of the fingernails, lips, skin, palms, or nail beds
  • change in consciousness
  • decreased awareness or responsiveness
  • loss of consciousness
  • severe sleepiness
  • sleepiness or unusual drowsiness

Some of the side effects that can occur with meperidine may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common
  • Drowsiness
  • nausea
  • relaxed and calm
  • vomiting
Incidence not known
  • Anxiety
  • blurred or loss of vision
  • confusion about identity, place, and time
  • difficulty having a bowel movement (stool)
  • disturbed color perception
  • double vision
  • dry mouth
  • false or unusual sense of well-being
  • halos around lights
  • headache
  • hives or welts
  • hyperventilation
  • irritability
  • nervousness
  • night blindness
  • overbright appearance of lights
  • redness of the skin
  • restlessness
  • seeing, hearing, or feeling things that are not there
  • trouble with sleeping
  • tunnel vision
  • weakness

For Healthcare Professionals

Applies to meperidine: compounding powder, injectable solution, intravenous solution, oral syrup, oral tablet

Nervous system

Central nervous system side effects have included sleepiness, lightheadedness, sedation, sweating, agitation, tremor, mood changes (e.g., euphoria, dysphoria), weakness, headache, disorientation, respiratory depression, delirium, seizures, tremors, dizziness, visual disturbances (e.g., transient hallucinations), muscle twitches, dilated pupils, and Parkinsonian symptoms.[Ref]

Central nervous system side effects may be either depressant or excitatory. Excitatory symptoms are sometimes ignored as possible side effects of meperidine, but may be due to the accumulation of a metabolite, normeperidine. Accumulation of normeperidine occurs more frequently in patients with renal insufficiency and in patients who are receiving meperidine via a patient-controlled analgesia pump.

Severe adverse effects, such as respiratory depression, may be treated with the opioid antagonist naloxone.[Ref]

Psychiatric

Psychiatric side effects include fearfulness, agitation, paranoia, hypervigilance, and auditory and visual hallucinations.[Ref]

Psychological dependence on meperidine may develop.[Ref]

Gastrointestinal

Gastrointestinal side effects including increased gastroesophageal reflux, increased biliary pressure, dry mouth, nausea, and vomiting have been reported.[Ref]

Meperidine may cause contraction of the sphincter of Oddi, thereby increasing intrabiliary pressure. As a result, meperidine may aggravate rather than relieve biliary colic.

Constipation is less common with meperidine than some other narcotics.[Ref]

Hypersensitivity

Hypersensitivity side effects including anaphylaxis and shock have been reported.[Ref]

Other

Other side effects including an opioid abstinence or withdrawal syndrome has been reported.[Ref]

The opioid abstinence or withdrawal syndrome is characterized by some or all of the following: restlessness, lacrimation, rhinorrhea, yawning, perspiration, chills, myalgia, mydriasis. Other symptoms also may also develop, including: irritability, anxiety, backache, joint pain, weakness, abdominal cramps, insomnia, nausea, anorexia, vomiting, diarrhea, or increased blood pressure, respiratory rate, or heart rate.[Ref]

Respiratory

There are case reports of bronchospasm occurring in patients with a history of asthma after receiving meperidine (the active ingredient contained in Demerol) Because of this effect and possible respiratory depression, meperidine should be used with caution in patients with severe reactive or obstructive pulmonary disease.[Ref]

Respiratory side effects including bronchospasm have been reported in patients with underlying pulmonary disease.[Ref]

Cardiovascular

Cardiovascular side effects including phlebitis have been reported. Hypotension has been reported rarely.[Ref]

Hypotension occurs most commonly in patients who are under anesthesia, who are dehydrated, and who are receiving other medications.[Ref]

Genitourinary

Genitourinary side effects including urinary retention have been reported.[Ref]

Dermatologic

Dermatologic side effects including rash, pruritus, and sweating have been reported.[Ref]

Musculoskeletal

Musculoskeletal side effects including a case of meperidine-induced muscular rigidity have been reported.[Ref]

References

1. Mather LE, Meffin PJ "Clinical pharmacokinetics pethidine." Clin Pharmacokinet 3 (1978): 352-68

2. Pond SM, Tong T, Benowitz NL, et al "Presystemic metabolism of meperidine to normeperidine in normal and cirrhotic subjects." Clin Pharmacol Ther 30 (1981): 183-8

3. Olive JM, Masana L, Gonzalez J "Meperidine and reversible parkinsonism." Mov Disord 9 (1994): 115-6

4. Stone PA, Macintyre PE, Jarvis DA "Norpethidine toxicity and patient controlled analgesia." Br J Anaesth 71 (1993): 738-40

5. Shaw HL "Treatment of intractable cancer pain by electronically controlled parenteral infusion of analgesic drugs." Cancer 72 (1993): 3416-25

6. Hagmeyer KO, Mauro LS, Mauro VF "Meperidine-related seizures associated with patient-controlled analgesia pumps." Ann Pharmacother 27 (1993): 29-32

7. Mauro VF, Bonfiglio MF, Spunt AL "Meperidine-induced seizure in a patient without renal dysfunction or sickle cell anemia." Clin Pharm 5 (1986): 837-9

8. Marcantonio ER, Juarez G, Goldman L, et al. "The relationship of postoperative delirium with psychoactive medications." JAMA 272 (1994): 1518-22

9. Rigg JR, Ilsley AH, Vedig AE "Relationship of ventilatory depression to steady-state blood pethidine concentrations." Br J Anaesth 53 (1981): 613-9

10. Reutens DC, Stewart-Wynne EG "Norpethidine induced myoclonus in a patient with renal failure." J Neurol Neurosurg Psychiatry 52 (1989): 1450-1

11. Lewis WR, Perrino AC Jr "Transient neurological symptoms after subarachnoid meperidine." Anesth Analg 94 (2002): 213-4

12. Kaiko RF, Foley KM, Grabinski PY, et al "Central nervous system excitatory effects of meperidine in cancer patients." Ann Neurol 13 (1983): 180-5

13. Goetting MG, Thirman MJ "Neurotoxicity of meperidine." Ann Emerg Med 14 (1985): 1007-9

14. Lieberman AN, Goldstein M "Reversible parkinsonism reated to meperidine." N Engl J Med 312 (1985): 509

15. Armstrong PJ, Bersten A "Normeperidine toxicity." Anesth Analg 65 (1986): 536-8

16. Samuels SI, Rabinov W "Difficulty reversing drug-induced coma in a patient with sleep apnea." Anesth Analg 65 (1986): 1222-4

17. Geller RJ "Meperidine in patient-controlled analgesia: a near-fatal mishap." Anesth Analg 76 (1993): 655-7

18. Fogarty T, Murray GB "Psychiatric presentation of meperidine toxicity." J Clin Psychopharmacol 7 (1987): 116-7

19. Stanski DR, Cherry C, Bradley R, et al "Efficacy and safety of single doses of intramuscular ketorolac tromethamine compared with meperidine for postoperative pain." Pharmacotherapy 10 (1990): s40-4

20. Hey VM, Ostick DG, Mazumder JK, Lord WD "Pethidine, metoclopramide and the gastro-oesophageal sphincter." Anaesthesia 36 (1981): 173-6

21. Jones RM, Fiddian-Green R, Knight PR "Narcotic-induced choledochoduodenal sphincter spasm reversed by glucagon." Anesth Analg 59 (1980): 946-7

22. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.

23. Elloway R, Sherman S, Maas L, et al "Meperidine-induced bronchospasm." Gastrointest Endosc 38 (1992): 93

24. Petros JG, Mallen JK, Howe K, Rimm EB, Robillard RJ "Patient-controlled analgesia and postoperative urinary retention after open appendectomy." Surg Gynecol Obstet 177 (1993): 172-5

25. Kitagawa N, Oda M, Totoki T "Meperidine-induced muscular rigidity during spinal anesthesia?" Anesth Analg 103 (2006): 490-1

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