Yes

Analgesic, Narcotic

Dental: Adjunct in preoperative intravenous conscious sedation in patients undergoing dental surgery; alternate oral narcotic in patients allergic to codeine to treat moderate to moderate-severe pain

Medical: Management of moderate to severe pain; adjunct to anesthesia and preoperative sedation

C-II

B/D (if used for prolonged periods or in high doses at term)

Hypersensitivity to meperidine or any component; patients receiving MAO inhibitors presently or in the past 14 days

Use with caution in patients with pulmonary, hepatic, renal disorders, or increased intracranial pressure; use with caution in patients with renal failure or seizure disorders or those receiving high-dose meperidine; normeperidine (an active metabolite and CNS stimulant) may accumulate and precipitate twitches, tremors, or seizures; some preparations contain sulfites which may cause allergic reaction; not recommended as a drug of first choice for the treatment of chronic pain in the elderly due to the accumulation of normeperidine; for acute pain, its use should be limited to 1-2 doses; tolerance or drug dependence may result from extended use

>10%:

Cardiovascular: Hypotension

Central nervous system: Fatigue, drowsiness, dizziness

Gastrointestinal: Nausea, vomiting, constipation

Neuromuscular & skeletal: Weakness

Miscellaneous: Histamine release

1% to 10%:

Central nervous system: Nervousness, headache, restlessness, malaise, confusion

Gastrointestinal: Anorexia, stomach cramps, xerostomia, biliary spasm

Genitourinary: Ureteral spasms, decreased urination

Local: Pain at injection site

Respiratory: Dyspnea, shortness of breath

<1%: Mental depression, hallucinations, paradoxical CNS stimulation, increased intracranial pressure, rash, urticaria, paralytic ileus, physical and psychological dependence

Symptoms of overdose include CNS depression, respiratory depression, mydriasis, bradycardia, pulmonary edema, chronic tremors, CNS excitability, seizures

Treatment of an overdose includes support of the patient's airway, establishment of an I.V. line, and administration of naloxone 2 mg I.V. (0.01 mg/kg for children) with repeat administration as necessary up to a total of 10 mg.

CYP2D6 enzyme substrate

Increased toxicity: May aggravate the adverse effects of isoniazid; MAO inhibitors, fluoxetine, and other serotonin uptake inhibitors greatly potentiate the effects of meperidine; acute opioid overdosage symptoms can be seen, including severe toxic reactions; CNS depressants, tricyclic antidepressants, phenothiazines may potentiate the effects of meperidine

Meperidine injection should be stored at room temperature and protected from light and freezing; protect oral dosage forms from light

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

Oral, S.C., I.M.:

Onset of analgesic effect: Within 10-15 minutes

Peak effect: Within 1 hour

Duration: 2-4 hours

I.V.: Onset of effects: Within 5 minutes

Distribution: Crosses the placenta; appears in breast milk

Protein binding: 65% to 75%

Metabolism: In the liver

Bioavailability: ~50% to 60%; increased with liver disease

Half-life:

Parent drug: Terminal phase: Neonates: 23 hours; range: 12-39 hours; Adults: 2.5-4 hours; Adults with liver disease: 7-11 hours

Normeperidine (active metabolite): 15-30 hours; is dependent on renal function and can accumulate with high doses or in patients with decreased renal function

Doses should be titrated to appropriate analgesic effect; when changing route of administration, note that oral doses are about half as effective as parenteral dose

Adults: Oral, I.M., I.V.: S.C.: 50-150 mg/dose every 3-4 hours as needed

Elderly:

Oral: 50 mg every 4 hours

I.M.: 25 mg every 4 hours

Dosing adjustment in renal impairment:

Cl_cr 10-50 mL/minute: Administer at 75% of normal dose

Cl_cr <10 mL/minute: Administer at 50% of normal dose

Dosing adjustment/comments in hepatic disease: Increased narcotic effect in cirrhosis; reduction in dose more important for oral than I.V. route

Alcohol: Additive CNS effects, avoid or limit alcohol; watch for sedation

Food: Glucose may cause hyperglycemia; monitor blood glucose concentrations

Pain relief, respiratory and mental status, blood pressure; observe patient for excessive sedation, CNS depression, seizures, respiratory depression

Therapeutic: 70-500 ng/mL (SI: 283-2020 nmol/L); Toxic: >1000 ng/mL (SI: >4043 nmol/L)

amylase (S), BSP retention, CPK (I.M. injections)

Sedation is common; may cause nervousness or confusion; may rarely produce depression, hallucinations, or paradoxical CNS stimulation

Sedation is common; may cause nervousness or confusion; may rarely produce depression, hallucinations, or paradoxical CNS stimulation

No information available to require special precautions

1% to 10% of patients experience dry mouth

If self-administered, use exactly as directed (do not increase dose or frequency); may cause physical and/or psychological dependence. While using this medication, do not use alcohol and other prescription or OTC medications (especially sedatives, tranquilizers, antihistamines, or pain medications) without consulting prescriber. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). May cause hypotension, dizziness, drowsiness, impaired coordination, or blurred vision (use caution when driving, climbing stairs, or changing position - rising from sitting or lying to standing, or when engaging in tasks requiring alertness until response to drug is known); loss of appetite, nausea, or vomiting (frequent mouth care, small frequent meals, chewing gum, or sucking lozenges may help); constipation (increased exercise, fluids, or dietary fruit and fiber may help - if constipation remains an unresolved problem, consult prescriber about use of stool softeners). Report chest pain, slow or rapid heartbeat, acute dizziness or persistent headache; changes in mental status; swelling of extremities or unusual weight gain; changes in urinary elimination; acute headache; back or flank pain or muscle spasms; blurred vision; skin rash; or shortness of breath. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Do not breast-feed.

If I.V. administration is required, inject very slowly using a diluted solution; administer over at least 5 minutes; intermittent infusion: dilute to 1 mg/mL and administer over 15-30 minutes; dilute to less than or equal to 10 mg/mL for intermittent I.V. use

Injection, as hydrochloride:

Multiple-dose vials: 50 mg/mL (30 mL); 100 mg/mL (20 mL)

Single-dose: 10 mg/mL (5 mL, 10 mL, 30 mL); 25 mg/dose (0.5 mL, 1 mL); 50 mg/dose (1 mL); 75 mg/dose (1 mL, 1.5 mL); 100 mg/dose (1 mL)

Syrup, as hydrochloride: 50 mg/5 mL (500 mL)

Tablet, as hydrochloride: 50 mg, 100 mg

American Academy of Pediatrics Committee on Drugs, "Reappraisal of Lytic Cocktail/Demerol®, Phenergan®, and Thorazine® (DPT) for the Sedation of Children," Pediatrics, 1995, 95(4):598-602.

Armstrong PJ and Bersten A, "Normeperidine Toxicity," Anesth Analg, 1986, 65(5):536-8.

Buchanan JF and Brown CR, "Designer Drugs: A Problem in Clinical Toxicology," Med Toxicol Adverse Drug Exp, 1988, 3(1):1-17.

Cole TB, Sprinkle RH, Smith SJ, et al, "Intravenous Narcotic Therapy for Children With Severe Sickle Cell Pain Crisis," Am J Dis Child, 1986, 140(12):1255-9.

"Drugs for Pain," Med Lett Drugs Ther, 1998, 40(1033):79-84.

Ferrell BA, "Pain Management in Elderly People," J Am Geriatr Soc, 1991, 39(1):64-73.

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Miller RR and Jick H, "Clinical Effects of Meperidine in Hospitalized Medical Patients," J Clin Pharmacol, 1978, 18(4):180-9.

Olkkola KT, Hamunen K, and Maunuksela EL, "Clinical Pharmacokinetics and Pharmacodynamics of Opioid Analgesics in Infants and Children," Clin Pharmacokinet, 1995, 28(5):385-404.

Pokela ML, Olkkola KT, Koivisto ME, et al, "Pharmacokinetics and Pharmacodynamics of Intravenous Meperidine in Neonates and Infants," Clin Pharmacol Ther, 1992, 52(4):342-9.

Stone PA, Macintyre PE, and Jarvis DA, "Norpethidine Toxicity and Patient Controlled Analgesia," Br J Anaesth, 1993, 71(5):738-40.