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Meperidine

Pronunciation

Pronunciation

(me PER i deen)

Index Terms

  • Isonipecaine Hydrochloride
  • Meperidine Hydrochloride
  • Pethidine Hydrochloride

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Injection, as hydrochloride:

Demerol: 25 mg/mL (1 mL); 25 mg/0.5 mL (0.5 mL); 50 mg/mL (1 mL, 30 mL); 75 mg/1.5 mL (1.5 mL); 100 mg/2 mL (2 mL); 75 mg/mL (1 mL); 100 mg/mL (1 mL, 20 mL)

Generic: 10 mg/mL (30 mL); 25 mg/mL (1 mL); 50 mg/mL (1 mL); 100 mg/mL (1 mL)

Solution, Oral, as hydrochloride:

Generic: 50 mg/5 mL (500 mL)

Tablet, Oral, as hydrochloride:

Demerol: 50 mg [DSC]

Demerol: 50 mg [DSC] [scored]

Demerol: 100 mg

Generic: 50 mg, 100 mg

Brand Names: U.S.

  • Demerol

Pharmacologic Category

  • Analgesic, Opioid

Pharmacology

Binds to opioid receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; produces generalized CNS depression

Absorption

IM, Oral: Erratic and highly variable

Distribution

Vdss:

Neonates: Preterm 1 to 7 days: 8.8 L/kg; term 1 to 7 days: 5.6 L/kg

Infants: 1 week to 2 months: 8 L/kg

Infants and Children: 3 to 18 months: 5 L/kg

Children: 5 to 8 years: 2.8 L/kg

Adults: 3 to 4 L/kg

Metabolism

Hepatic; hydrolyzed to meperidinic acid (inactive) or undergoes N-demethylation to normeperidine (active; has 1/2 the analgesic effect and 2 to 3 times the CNS effects of meperidine)

Excretion

Urine (as metabolites; ~5% as unchanged drug)

Onset of Action

Onset of action: Analgesic: Oral, IM, SubQ: 10 to 15 minutes; IV: ∼5 minutes. Peak effect: IV: 5 to 7 minutes; IM, SubQ.: ~1 hour; Oral: 2 hours

Duration of Action

Oral, IM, SubQ.: 2 to 4 hours; IV: 2 to 3 hours

Half-Life Elimination

Parent drug: Terminal phase:

Preterm infants 3.6 to 65 days of age: 11.9 hours (range: 3.3 to 59.4 hours)

Term infants: 0.3 to 4 days of age: 10.7 hours (range: 4.9 to 16.8 hours); 26 to 73 days of age: 8.2 hours (range: 5.7 to 31.7 hours)

Neonates: 23 hours (range: 12 to 39 hours)

Infants 3 to 18 months: 2.3 hours

Children 5 to 8 years: 3 hours

Adults: 2.5 to 4 hours, Liver disease: 7 to 11 hours

Normeperidine (active metabolite): Neonates: 30 to 85 hours; Adults: 8 to 16 hours; normeperidine half-life is dependent on renal function and can accumulate with high doses or in patients with decreased renal function; normeperidine may precipitate tremors or seizures

Protein Binding

To alpha 1-acid glycoprotein: Neonates: 52%; Infants: 3 to 18 months: 85%; Adults: 65% to 75%

Special Populations: Renal Function Impairment

Accumulation of meperidine and/or normeperidine may occur.

Special Populations: Hepatic Function Impairment

Accumulation of meperidine and/or normeperidine may occur. Half-life is 1.3 to 2 times greater in cirrhotic patients.

Special Populations: Elderly

Elderly patients have a slower elimination rate.

Special Populations Note

Postoperative patients: The half-life is 1.3 to 2 times greater in these patients.

Use: Labeled Indications

Management of moderate to severe pain; preoperative sedation, and obstetrical analgesia

Use: Unlabeled

Reduce postoperative shivering; reduce rigors from amphotericin B (conventional)

Contraindications

Hypersensitivity to meperidine or any component of the formulation; use with or within 14 days of MAO inhibitors.

Documentation of allergenic cross-reactivity for opioid analgesics is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.

Dosing: Adult

Note: The American Pain Society (2008) and ISMP (2007) do not recommend meperidine’s use as an analgesic. If use in acute pain (in patients without renal or CNS disease) cannot be avoided, treatment should be limited to ≤48 hours and doses should not exceed 600 mg/24 hours. Oral route is not recommended for treatment of acute or chronic pain. If IV route is required, consider a reduced dose. Patients with prior opioid exposure may require higher initial doses.

Pain, moderate to severe (analgesic): Oral, IM, SubQ: 50 to 150 mg every 3 to 4 hours as needed

Preoperatively: IM, SubQ: 50 to 100 mg given 30 to 90 minutes before the beginning of anesthesia

Obstetrical analgesia: IM, SubQ: 50 to 100 mg when pain becomes regular; may repeat at every 1- to 3-hour intervals

Postoperative shivering (off-label use): IV: 25 to 50 mg once (Crowley 2008; Kranke 2002; Mercandante 1994; Wang 1999)

Dosing: Geriatric

Avoid use (American Pain Society 2008; ISMP 2007).

Dosing: Pediatric

Note: The American Pain Society (2008) and ISMP (2007) do not recommend meperidine’s use as an analgesic. If use in acute pain (in patients without renal or CNS disease) cannot be avoided, treatment should be limited to ≤48 hours and doses should not exceed 600 mg/24 hours. Oral route is not recommended for treatment of acute or chronic pain. If IV route is required, consider a reduced dose. Patients with prior opioid exposure may require higher initial doses.

Pain, moderate to severe (analgesic): Oral, IM, SubQ: 1.1 to 1.8 mg/kg/dose every 3 to 4 hours as needed (maximum: 50 to 150 mg/dose)

Preoperatively: IM, SubQ: 1.1 to 2.2 mg/kg given 30 to 90 minutes before the beginning of anesthesia (maximum: 50 to 100 mg/dose)

Dosing: Renal Impairment

Avoid use in renal impairment (American Pain Society 2008; ISMP 2007).

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer’s labeling; use with caution in severe hepatic impairment; consider a lower initial dose when initiating therapy. An increased opioid effect may be seen in patients with cirrhosis; dose reduction is more important for the oral than IV route.

Administration

Injection: May administer IM, SubQ, or IV (patient should be lying down during administration); IV push should be administered slowly using a diluted solution, use of a 10 mg/mL concentration has been recommended. IM administration is preferred when repeated doses are required.

Oral solution: Administer solution in 1/2 glass of water; undiluted solution may exert topical anesthetic effect on mucous membranes

Compatibility

Stable in dextran 6% in dextrose, dextran 6% in NS, D5LR, D51/4NS, D51/2NS, D5NS, D5W, D10W, LR, 1/2NS, NS.

Y-site administration: Incompatible with allopurinol, amphotericin B cholesteryl sulfate complex, cefepime, doxorubicin liposome, idarubicin, imipenem/cilastatin, micafungin, minocycline.

Compatibility in syringe: Incompatible with ceftriaxone, furosemide, heparin, morphine, pantoprazole, pentobarbital, thiopental.

Storage

Injection: Store at 20°C to 25°C (68°F to 77°F).

Tablets: Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F).

Drug Interactions

Alvimopan: Analgesics (Opioid) may enhance the adverse/toxic effect of Alvimopan. This is most notable for patients receiving long-term (i.e., more than 7 days) opiates prior to alvimopan initiation. Management: Alvimopan is contraindicated in patients receiving therapeutic doses of opioids for more than 7 consecutive days immediately prior to alvimopan initiation. Consider therapy modification

Amphetamines: May enhance the analgesic effect of Analgesics (Opioid). Monitor therapy

Analgesics (Opioid): CNS Depressants may enhance the CNS depressant effect of Analgesics (Opioid). Management: Avoid concomitant use of opioid analgesics and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification

Anticholinergic Agents: May enhance the adverse/toxic effect of Analgesics (Opioid). Specifically, the risk for constipation and urinary retention may be increased with this combination. Monitor therapy

Antiemetics (5HT3 Antagonists): May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Monitor therapy

Azelastine (Nasal): CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal). Avoid combination

Blonanserin: CNS Depressants may enhance the CNS depressant effect of Blonanserin. Consider therapy modification

Brimonidine (Topical): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Cannabis: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Chlorphenesin Carbamate: May enhance the adverse/toxic effect of CNS Depressants. Monitor therapy

Cimetidine: May increase the serum concentration of Meperidine. Monitor therapy

CNS Depressants: May enhance the CNS depressant effect of Analgesics (Opioid). Management: Avoid concomitant use of opioid analgesics and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification

Dapoxetine: May enhance the adverse/toxic effect of Serotonin Modulators. Avoid combination

Desmopressin: Analgesics (Opioid) may enhance the adverse/toxic effect of Desmopressin. Monitor therapy

Dimethindene (Systemic): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Diuretics: Analgesics (Opioid) may enhance the adverse/toxic effect of Diuretics. Analgesics (Opioid) may diminish the therapeutic effect of Diuretics. Monitor therapy

Dronabinol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Droperidol: May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (e.g., opioids, barbiturates) with concomitant use. Consider therapy modification

Eluxadoline: Analgesics (Opioid) may enhance the constipating effect of Eluxadoline. Avoid combination

Flunitrazepam: CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. Consider therapy modification

Fosphenytoin: May decrease the serum concentration of Meperidine. Monitor therapy

Gastrointestinal Agents (Prokinetic): Analgesics (Opioid) may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Monitor therapy

HYDROcodone: CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification

HydrOXYzine: May enhance the CNS depressant effect of Meperidine. Management: Consider a decrease in meperidine dose, as appropriate, when used together with hydroxyzine. With concurrent use, monitor patients closely for excessive response to the combination. Consider therapy modification

Kava Kava: May enhance the adverse/toxic effect of CNS Depressants. Monitor therapy

Lofexidine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Magnesium Sulfate: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

MAO Inhibitors: May enhance the serotonergic effect of Meperidine. This may cause serotonin syndrome. Avoid combination

Methotrimeprazine: May enhance the CNS depressant effect of CNS Depressants. CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established. Consider therapy modification

Methylene Blue: May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Avoid combination

Metoclopramide: Serotonin Modulators may enhance the adverse/toxic effect of Metoclopramide. This may be manifest as symptoms consistent with serotonin syndrome or neuroleptic malignant syndrome. Monitor therapy

MetyroSINE: CNS Depressants may enhance the sedative effect of MetyroSINE. Monitor therapy

Minocycline: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Mixed Agonist / Antagonist Opioids: May diminish the analgesic effect of Analgesics (Opioid). Management: Seek alternatives to mixed agonist/antagonist opioids in patients receiving pure opioid agonists, and monitor for symptoms of therapeutic failure/high dose requirements (or withdrawal in opioid-dependent patients) if patients receive these combinations. Avoid combination

Nabilone: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Nalmefene: May diminish the therapeutic effect of Analgesics (Opioid). Management: Avoid the concomitant use of nalmefene and opioid analgesics. Discontinue nalmefene 1 week prior to any anticipated use of opioid analgesics. If combined, larger doses of opioid analgesics will likely be required. Consider therapy modification

Naltrexone: May diminish the therapeutic effect of Analgesics (Opioid). Management: Seek therapeutic alternatives to opioids. See full drug interaction monograph for detailed recommendations. Consider therapy modification

Orphenadrine: CNS Depressants may enhance the CNS depressant effect of Orphenadrine. Avoid combination

OxyCODONE: CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification

Paraldehyde: CNS Depressants may enhance the CNS depressant effect of Paraldehyde. Avoid combination

Pegvisomant: Analgesics (Opioid) may diminish the therapeutic effect of Pegvisomant. Monitor therapy

Perampanel: May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination. Consider therapy modification

Phenytoin: May decrease the serum concentration of Meperidine. Monitor therapy

Piribedil [INT]: CNS Depressants may enhance the CNS depressant effect of Piribedil [INT]. Monitor therapy

Pramipexole: CNS Depressants may enhance the sedative effect of Pramipexole. Monitor therapy

Protease Inhibitors: May enhance the adverse/toxic effect of Meperidine. Protease Inhibitors may decrease the serum concentration of Meperidine. Concentrations of the toxic Normeperidine metabolite may be increased. Consider therapy modification

Ramosetron: Analgesics (Opioid) may enhance the constipating effect of Ramosetron. Monitor therapy

ROPINIRole: CNS Depressants may enhance the sedative effect of ROPINIRole. Monitor therapy

Rotigotine: CNS Depressants may enhance the sedative effect of Rotigotine. Monitor therapy

Rufinamide: May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced. Monitor therapy

Selective Serotonin Reuptake Inhibitors: CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced. Monitor therapy

Serotonin Modulators: May enhance the adverse/toxic effect of other Serotonin Modulators. The development of serotonin syndrome may occur. Exceptions: Nicergoline; Tedizolid. Monitor therapy

Serotonin Modulators: Analgesics (Opioid) may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Exceptions: Nicergoline. Monitor therapy

Sodium Oxybate: May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated. Consider therapy modification

Succinylcholine: May enhance the bradycardic effect of Analgesics (Opioid). Monitor therapy

Suvorexant: CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Consider therapy modification

Tapentadol: May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification

Tetrahydrocannabinol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Thalidomide: CNS Depressants may enhance the CNS depressant effect of Thalidomide. Avoid combination

Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Consider therapy modification

Test Interactions

Increased amylase (S), increased BSP retention, increased CPK (IM injections)

Adverse Reactions

Frequency not defined.

Cardiovascular: Bradycardia, cardiac arrest, circulatory depression, flushing, hypotension, palpitations, shock, syncope, tachycardia

Central nervous system: Agitation, confusion, delirium, disorientation, dizziness, drug dependence (physical dependence), habituation, hallucination, headache, increased intracranial pressure, involuntary muscle movements (including muscle twitching, myoclonus), mood changes (including euphoria, dysphoria), sedation, seizure (associated with metabolite accumulation), serotonin syndrome

Dermatologic: Diaphoresis, pruritus, skin rash, urticaria

Gastrointestinal: Biliary colic, constipation, nausea, spasm of sphincter of Oddi, vomiting, xerostomia

Genitourinary: Urinary retention

Hypersensitivity: Anaphylaxis, histamine release, hypersensitivity reaction

Local: Injection site reaction (including pain, wheal, and flare)

Neuromuscular & skeletal: Tremor, weakness

Ophthalmic: Visual disturbance

Respiratory: Dyspnea, respiratory arrest, respiratory depression

<1% (Limited to important or life-threatening): Hypogonadism (Brennan 2013; Debono 2011)

Warnings/Precautions

Concerns related to adverse effects:

• CNS depression: May cause CNS depression, which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving).

• CNS events: Normeperidine (an active metabolite and CNS stimulant) may accumulate and precipitate anxiety, tremors, or seizures; risk increases with preexisting CNS or renal dysfunction, prolonged use (>48 hours), and cumulative dose (>600 mg/24 hours in adults). Oral meperidine should not be used since first-pass metabolism decreases efficacy while increasing normeperidine concentrations (American Pain Society 2008). Note: Naloxone does not reverse, and may even worsen, neurotoxicity.

• Hypotension: May cause hypotension (including orthostatic hypotension); use with caution in patients with hypovolemia, cardiovascular disease (including acute MI), or drugs which may exaggerate hypotensive effects (including phenothiazines or general anesthetics).

Disease-related concerns:

• Abdominal conditions: May obscure diagnosis or clinical course of patients with acute abdominal conditions.

• Adrenal insufficiency: Use with caution and reduce initial dosage in patients with adrenal insufficiency, including Addison disease. Long-term opioid use may cause secondary hypogonadism, which may lead to sexual dysfunction, infertility, mood disorders, and osteoporosis (Brennan 2013).

• Biliary tract impairment: Use with caution in patients with biliary tract dysfunction, including acute pancreatitis; may cause constriction of sphincter of Oddi.

• CNS depression/coma: Avoid use in patients with CNS depression or coma as these patients are susceptible to intracranial effects of CO2 retention.

• Delirium tremens: Use with caution in patients with delirium tremens.

• Drug abuse: Use with caution in patients with a history of drug abuse or acute alcoholism; potential for drug dependency exists. Tolerance, psychological and physical dependence may occur with prolonged use.

• Head trauma: Use with extreme caution in patients with head injury, intracranial lesions, or elevated intracranial pressure; exaggerated elevation of ICP may occur; may obscure clinical course of patients with head injury.

• Hepatic impairment: Use with caution in patients with hepatic disorders; meperidine and to a lesser degree normeperidine may accumulate and precipitate either CNS depression or CNS excitation (eg, anxiety, tremors, or seizures) (Danzinger, 1994; Tegeder, 1999).

• Obesity: Use with caution in patients who are morbidly obese.

• Prostatic hyperplasia/urinary stricture: Use with caution and reduce initial dosage in patients with prostatic hyperplasia and/or urinary stricture.

• Renal impairment: Avoid use in patients with renal impairment (American Pain Society 2008; ISMP 2007); normeperidine may accumulate and precipitate anxiety, tremors, or seizures.

• Respiratory disease: Use with extreme caution in patients having an acute asthma attack, with chronic obstructive pulmonary disease or cor pulmonale and patients having a substantially decreased respiratory reserve, hypoxia, hypercarbia, or preexisting respiratory depression; even therapeutic doses may decrease respiratory drive to the point of apnea.

• Seizure disorders: Use with caution in patients with seizure disorders, may cause or aggravate seizures if high doses used or from prolonged use (accumulation of metabolite).

• Sickle-cell disease: In patients with sickle cell anemia, use with caution and decrease initial dose; normeperidine (active metabolite) may accumulate and induce seizures in these patients; Note: Meperidine is not recommended for use in sickle cell patients by the American Pain Society (APS 2008) and should only be used in sickle cell patients with a vaso-occlusive crisis (VOC) if it is the only effective opioid for an individual patient (NHLBI 2014).

• Tachycardia: Use with caution in patients with supraventricular tachycardia (including atrial flutter); use may increase ventricular response rate possibly due to a vagolytic effect.

• Thyroid dysfunction: Use with caution in patients with thyroid dysfunction, including hypothyroidism; reduce initial dosage.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

Special populations:

• Debilitated patients: Use with caution in debilitated patients; there is a greater potential for critical respiratory depression, even at therapeutic dosages; reduce initial dosage.

• Elderly: Avoid the use of meperidine for pain control, especially in elderly and renally compromised patients because of the risk of neurotoxicity (American Pain Society 2008; Institute for Safe Medication Practices [ISMP] 2007).

• Neonates: Neonatal withdrawal syndrome: After chronic maternal exposure to opioids, neonatal withdrawal syndrome may occur in the newborn; monitor neonate closely. Signs and symptoms include irritability, hyperactivity and abnormal sleep pattern, high pitched cry, tremor, vomiting, diarrhea and failure to gain weight. Onset, duration and severity depend on the drug used, duration of use, maternal dose, and rate of drug elimination by the newborn. Opioid withdrawal syndrome in the neonate, unlike in adults, may be life-threatening and should be treated according to protocols developed by neonatology experts.

Dosage form specific issues:

• Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer’s labeling.

• Sulfites: Some preparations may contain sulfites which may cause allergic reaction.

Other warnings/precautions:

• Abuse/misuse/diversion: Healthcare provider should be alert to problems of abuse, misuse, and diversion.

• Acute and/or cancer pain management: Meperidine offers no advantage over other opioids as an analgesic and has unique neurotoxicity. The use of meperidine in this setting should be avoided (American Pain Society [APS] 2008; ISMP 2007).

• Chronic pain management: Use is not recommended for the management of chronic pain.

• Withdrawal: Abrupt discontinuation following prolonged use may lead to withdrawal symptoms.

Monitoring Parameters

Pain relief, respiratory and mental status, blood pressure; observe patient for excessive sedation, CNS depression, seizures, respiratory depression; signs or symptoms of hypogonadism or hypoadrenalism (Brennan 2013)

Pregnancy Risk Factor

C

Pregnancy Considerations

Animal reproduction studies have not been conducted by the manufacturer. Meperidine crosses the placenta; meperidine and its active metabolite accumulate in the fetus. Respiratory or CNS depression should be expected to occur in the newborn if maternal IM administration occurs within a few hours of delivery (Mattingly 2003). When used for pain relief during labor, opioids may temporarily affect the heart rate of the fetus. Due to the prolonged half-life of the active metabolite, dose-dependent sedation in the neonate may be observed for 2-3 days following delivery. Meperidine has been used for the management of pain during labor; however, due to adverse maternal and fetal effects, other opioids may be preferred. Meperidine should also be avoided following delivery when postoperative analgesia is needed (ACOG 2002).

If chronic opioid exposure occurs in pregnancy, adverse events in the newborn (including withdrawal) may occur; monitoring of the neonate is recommended. The minimum effective dose should be used if opioids are needed (Chou 2009). Neonatal abstinence syndrome following opioid exposure may present with autonomic (eg, fever, temperature instability), gastrointestinal (eg, diarrhea, vomiting, poor feeding/weight gain), or neurologic (eg, high-pitched crying, increased muscle tone, irritability, seizure, tremor) symptoms (Dow 2012; Hudak 2012).

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience fatigue, flushing, lack of appetite, or sweating a lot. Have patient report immediately to prescriber severe dizziness, passing out, confusion, severe nausea, severe vomiting, severe constipation, severe loss of strength and energy, seizures, angina, tachycardia, bradycardia, arrhythmia, difficult urination, hallucinations, mood changes, severe abdominal pain, difficulty breathing, slow breathing, shallow breathing, severe headache, tremors, abnormal movements, vision changes, signs of adrenal gland problems (severe nausea, vomiting, severe dizziness, passing out, muscle weakness, severe fatigue, mood changes, lack of appetite, or weight loss), or signs of serotonin syndrome (dizziness, severe headache, agitation, hallucinations, tachycardia, arrhythmia, flushing, tremors, sweating a lot, change in balance, severe nausea, or severe diarrhea) (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

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