Meperidine Hydrochloride Injection Shortage

• • Demerol injection, Pfizer, 100 mg/mL, 1 mL Carpuject syringe, 10 count, NDC 00409-1180-69
  • Demerol injection, Pfizer, 25 mg/mL, 1 mL Carpuject syringe, 10 count, NDC 00409-1176-30
  • Demerol injection, Pfizer, 25 mg/mL, 1 mL Nexject prefilled syringe 10 count, NDC 00409-1362-01
  • Demerol injection, Pfizer, 50 mg/mL, 1 mL Carpuject syringe, 10 count, NDC 00409-1178-30
  • Demerol injection, Pfizer, 50 mg/mL, 1 mL Nexject prefilled syringe 10 count, NDC 00409-1418-01
  • Demerol injection, Pfizer, 50 mg/mL, 30 mL multiple dose vial, 1 count, NDC 00409-1181-30
  • Demerol injection, Pfizer, 75 mg/mL, 1 mL Carpuject syringe, 10 count, NDC 00409-1179-30
  • Meperidine injection, Hikma, 100 mg/mL, 1 mL vial, 25 count, NDC 00641-6054-25
  • Meperidine injection, Hikma, 25 mg/mL, 1 mL vial, 25 count, NDC 00641-6052-25
  • Meperidine injection, Hikma, 50 mg/mL, 1 mL vial, 25 count, NDC 00641-6053-25

• • Hikma did not provide a reason for the shortage.
  • Pfizer has Demerol on shortage due to manufacturing delays.

• • There are no presentations available

Estimated Resupply Dates

• • Hikma has meperidine 25 mg/mL 1 mL vials, 50 mg/mL 1 mL vials, and 100 mg/mL 1 mL vials on back order and the company cannot estimate a release date.
  • Pfizer has Demerol 25 mg/mL 1 mL Carpuject syringes and 50 mg/mL 1 mL Carpuject syringes on back order and the company estimates a release date of December 2025. The 50 mg/mL 30 mL vials are on back order and the company estimates a release date of September 2025. The 25 mg/mL 1 mL NexJect syringes, 50 mg/mL 1 mL NexJect syringes, 75 mg/mL 1 mL Carpuject syringes, and 100 mg/mL 1 mL Carpuject syringes are on back order and the company estimates a release date of December 2028.

Alternative Agents & Management

• • Meperidine is used off-label for post-operative shivering despite a lack of high quality evidence.[1-3] Other medications such as ketamine, tramadol, and clonidine also have limited evidence for post-operative shivering, and all pharmacologic options may result in unwanted adverse effects such as bradycardia with clonidine. The American Society of Anesthesiologists recommends non-pharmacologic measures such as forced-air warming devices initially, and meperidine if a pharmacologic agent is required.[1,4-5] Clinicians may choose to reserve remaining supplies of meperidine for patients with refractory post-operative shivering.[1]
  • Meperidine is used off-label for patients with a history rigors due to blood products where premedication with corticosteroids did not reduce the rigors sufficiently.[3]
  • Meperidine is used off-label for rigors associated with monoclonal antibody-related infusion reactions. A small open-label study found morphine 2 mg IV was similarly effective meperidine 25 mg IV for treating these rigors.[6]

References

• 1. Choi KE, Park B, Moheet AM, Rosen A, Lahiri S, Rosengart A. Systematic Quality Assessment of Published Antishivering Protocols. Anesth Analg. 2017 May;124(5):1539-1546. doi: 10.1213/ANE.0000000000001571. PMID: 27622717.
  2. Lopez MB. Postanaesthetic shivering - from pathophysiology to prevention. Rom J Anaesth Intensive Care. 2018 Apr;25(1):73-81. doi: 10.21454/rjaic.7518.251.xum. PMID: 29756066; PMCID: PMC5931188.
  3. Beckwith MC, Fox ER, Chandramouli J. Removing meperidine from the health-system formulary--frequently asked questions. J Pain Palliat Care Pharmacother. 2002;16(3):45-59. doi: 10.1080/j354v16n03_05. PMID: 14640355.
  4. Park SM, Mangat HS, Berger K, Rosengart AJ. Efficacy spectrum of antishivering medications: meta-analysis of randomized controlled trials. Crit Care Med. 2012 Nov;40(11):3070-82. doi: 10.1097/CCM.0b013e31825b931e. PMID: 22890247.
  5. Park B, Lee T, Berger K, Park SM, Choi KE, Goodsell TM, Rosengart A. Efficacy of Nonpharmacological Antishivering Interventions: A Systematic Analysis. Crit Care Med. 2015 Aug;43(8):1757-66. doi: 10.1097/CCM.0000000000001014. PMID: 26186477.
  6. Yakubi H, Steele AP, Tsao M. Meperidine compared to morphine for rigors associated with monoclonal antibody-related infusion reactions. J Oncol Pharm Pract. 2024 Jun 17:10781552241259986. doi: 10.1177/10781552241259986. Epub ahead of print. PMID: 38884818.