Names and pronunciation
(me-per′i-deen) Demerol
Source page 841
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Individual generic drug information
Extracted information for meperidine only.
(me-per′i-deen) Demerol
Source page 841
Func. class.: Opioid analgesic
Source page 841
Chem. class.: Phenylpiperidine derivative Controlled Substance Schedule II
Source page 841
Do not confuse: meperidine/HYDROmorphone/ meprobamate/morphine Demerol/Dilaudid
Source page 841
ACTION: Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors
Source page 841
USES: Moderate to severe pain preop- eratively, postoperatively, general anes- thesia maintenance, sedation induction
Source page 841
Unlabeled uses: Obstetric/regional anal- gesic, acute severe headache/migraine, shaking chills induced by IV amphotericin B or postoperative shivering
Source page 841
Extracted information for meperidine only.
CONTRAINDICATIONS: Hyper- sensitivity, GI obstruction, ileus
Source page 841
Black Box Warning: MAOI therapy, res- piratory depression Precautions: Pregnancy, breastfeeding, children, geriatric patients, addictive per- sonality, increased intracranial pressure, renal/hepatic disease, seizure disorder, abrupt discontinuation, chronic pain, car- diac disease, adrenal insufficiency, alco- holism, angina, anticoagulant therapy, asthma, atrial flutter, biliary tract disease, bladder obstruction, cardiac dysrhyth- mias, COPD, CNS depression, coagulopa- thy, constipation, cor pulmonale, dehydra- tion, diarrhea, driving, epidural use, M geriatric patients, GI obstruction, head trauma, heart failure, hypotension, hypo- thyroidism, ileus, IBS, IM/intrathecal/IV use, labor, myxedema, thrombocytopenia Black Box Warning: Coadministration with other CNS depressants, accidental exposure, neonatal opioid withdrawal syndrome, potential for overdose or poi- soning, substance abuse Black Box Warning: May cause fatal re- action: MAOIs, procarbazine within 14 days Increase: serotonin syndrome, neurolep- tic malignant syndrome—SSRIs, SNRIs, serotonin-receptor agonists, tricyclics, 5-HT3 receptor antagonists Increase: effects, severe respiratory depression with other CNS depressants, alcohol, opioids, sedative/hypnotics, antipsychotics, skeletal muscle relaxants Increase: adverse reactions—protease inhibitor antiretrovirals Increase: opioid toxicity—CYP3A4 inhibitors (fluconazole, ketoconazole, itraconazole, clarithromycin, nefazo- done, verampamil), avoid using together Decrease: meperidine effect—phenyt- oin, nalbuphine, pentazocine Increase: sedation—kava, hawthorn, lavender, valerian Drug/Herb Increase: CNS depression, serotonin syn- drome—St. John’s wort, avoid using together Drug/Lab Test Increase: amylase, lipase Black Box Warning: Opioids/benzodi- azepines: use only if alternative products cannot be used; excessive sedation and death may occur; if used, monitor closely • Abrupt discontinuation: withdraw slowly; if stopped abruptly, assess for withdrawal • Sex hormone changes: assess for libido, changes in menstrual cycle, erectile dys- function, infertility; if androgen deficiency is suspected, lab tests should be done • Adrenal insufficiency: assess for an- orexia, nausea, vomiting, decreased B/P, weakness; if suspected, confirm with cor- tisol, sodium, potassium levels; if pres- ent, do not abruptly discontinue meperi- dine, but gradually withdraw Black Box Warning: Serotonin syndrome when given with SSRIs, SNRIs, and seroto- nin receptor agonists: monitor for hyper- thermia, hypertension, rigidity, delirium, coma; do not use within 14 days of MAOIs • Bowel function: for constipation; in- crease fluids, bulk in diet; give stimulant laxatives if needed • CNS changes: dizziness, drowsi- ness, hallucinations, euphoria, LOC, pupil reactions with chronic or high- dose use; risk of toxicity increases with M >600 mg/day Black Box Warning: P450 3A4 inhibi- tors: avoid concomitant use as increased plasma concentrations of meperidine may occur, resulting in serious effects, respiratory depression, or death • Allergic reactions: rash, urticaria Black Box Warning: Respiratory dysfunc- tion: depression, character, rate, rhythm; notify prescriber if respirations are <12/min • CNS stimulation with chronic or high doses • Children: monitor for restlessness; changes in respirations may occur more frequently than in adults • Beers: avoid in older adults, especially those with chronic disease; may cause neu- rotoxicity; monitor for delirium frequently Black Box Warning: Pregnancy/breast- feeding: Avoid prolonged use during preg- nancy, risk of neonatal opioid withdrawal syndrome; notify prescriber of intended or suspected pregnancy; do not breastfeed Black Box Warning: Serotonin syn- drome: to report symptoms immediately
Source pages 841, 842, 843, 844
SIDE EFFECTS CNS: Drowsiness, dizziness, confu- sion, headache, sedation, eupho- ria, increased intracranial pressure, sei- zures, serotonin syndrome CV: Palpitations, bradycardia, hypoten- sion, change in B/P, tachycardia (IV) EENT: Tinnitus, blurred vision, miosis, diplopia, depressed corneal reflex GI: Nausea, vomiting, anorexia, constipa- tion, cramps, biliary spasm, paralytic ileus GU: Urinary retention, dysuria INTEG: Rash, urticaria, bruising, flush- ing, diaphoresis, pruritus RESP: Respiratory depression SYST: Anaphylaxis
Source page 842
INTERACTIONS
Source page 842
TREATMENT OF OVERDOSE: Naloxone (Narcan) 0.2-0.8 mg IV, cau- tion in physically dependent patients, O2, IV fluids, vasopressors
Source page 844
Extracted information for meperidine only.
DOSAGE AND ROUTES Severe pain • Adult: PO/SUBCUT/IM 50-150 mg q3-4hr prn; IV CONT INF 15-35 mg/hr • Child: PO/SUBCUT/IM 1-1.8 mg/kg q3-4hr prn, max single dose 150 mg; IV CONT INF 0.5-1 mg/kg loading dose then 0.3 mg/kg/hr PCA • Adult: IV 10 mg, range 1-5 mg incre- ments, lock out interval 6-10 min Labor analgesia • Adult: SUBCUT/IM 50-100 mg given when contractions regularly spaced, re- peat q1-3hr prn Preoperative analgesia • Adult: IM/SUBCUT 50-100 mg 30-90 min before surgery • Child: IM/SUBCUT 1-2.2 mg/kg 30- 90 min before surgery, max 100 mg Coadministration with other CNS depressants • Adult: PO/IM/SUBCUT/IV Reduce dose by 25%-50% Renal dose • Adult: PO/IM/SUBCUT/IV CCr 10-50 mL/min give 75% of dose; CCr <10 mL/ min give 50% of dose
Source pages 841, 842
Available forms: Inj 10, 25, 50, 75, 100 mg/mL; tabs 50, 100 mg; oral sol 50 mg/5 mL
Source page 842
Administer: • Doses given regularly before pain re- turns are more effective PO route • May give with food or milk to decrease GI irritation • Store in light-resistant container at room temperature • Do not use in severe respiratory insuf- ficiency • Oral solution: dilute in 4 oz water; less effective than IM IM/SUBCUT route • Patient should remain recumbent for 1 hr after IM/SUBCUT route • With antiemetic for nausea, vomiting • When pain beginning to return; deter- mine dosage interval by patient response • In gradually decreasing dose after long- term use; withdrawal symptoms may occur • Inject IM into large muscle mass; IM preferred route for multiple inj PCA route • Refer to package insert for instructions and agency protocol • Have emergency equipment and opiate/ antagonist nearby Direct IV route • Dilute to concentration of ≤10 mg/mL with sterile water for inj or NS • Inject slowly ≤25 mg/min over at least 5 min, rapid administration may cause respiratory depression, hypotension, cir- culatory collapse • Have emergency equipment and opiate antagonist on hand Intermittent IV INFUSION route • Dilute to concentration of 1 mg/mL • Infuse using infusion pump over 15-30 min, titrate Continuous intrathecal INFUSION route • Use controlled infusion device; im- plantable controlled microinfusion de- vice used for highly concentrated infu- sion; monitor for several days after implantation • Filling of infusion reservoir should be done only by those fully qualified • To prevent pain, depletion of reservoir should be avoided
Source page 842
Extracted information for meperidine only.
Assess: • Pain: location, type, character; give product before pain becomes extreme; reassess after 60 min (IM, SUBCUT, PO) and 5-10 min (IV) • B/P, pulse, respirations baseline and during use • Renal function prior to initiating ther- apy; poor renal function can lead to ac- cumulation of toxic metabolite and sei- zures; monitor BUN, serum creatinine • I&O ratio; check for decreasing out- put; may indicate urinary retention
Source page 843
Evaluate: • Therapeutic response: decrease in pain
Source page 844
CLINICAL CONSIDERATIONS
Source page 843
Patient and caregiver information: • To report any symptoms of CNS changes, allergic reactions • That physical dependency may result from extended use; use should be short- term only • That drowsiness, dizziness may occur • That withdrawal symptoms may occur: nausea, vomiting, cramps, fever, faint- ness, anorexia • To make position changes slowly; or- thostatic hypotension can occur • To avoid OTC medications, alcohol, herbals unless directed by prescriber • Not to be used long term • That nausea may be decreased by lying down
Source page 844
Extracted information for meperidine only.
PHARMACOKINETICS Metabolized by liver (to active/inactive metabolites), excreted by kidneys; crosses placenta, excreted in breast milk; half-life 3-4 hr; toxic by-product accu- mulation can result from regular use or renal disease; protein binding 65%-75% PO: Onset 15 min, peak 1.5 hr, duration 2-4 hr, absorption 50% SUBCUT/IM: Onset 10 min, peak 30-60 min, duration 2-4 hr, well absorbed IV: Onset immediate, peak 5-7 min, duration 2 hr
Source page 842
Filter the extracted dose blocks for this individual drug.
Severe pain
• Adult: PO/SUBCUT/IM 50-150 mg q3-4hr prn; IV CONT INF 15-35 mg/hr
Candidate age grouping · source pages 841, 842
Severe pain
• Adult: IV 10 mg, range 1-5 mg incre- ments, lock out interval 6-10 min Labor analgesia
Candidate age grouping · source pages 841, 842
Severe pain
• Adult: SUBCUT/IM 50-100 mg given when contractions regularly spaced, re- peat q1-3hr prn Preoperative analgesia
Candidate age grouping · source pages 841, 842
Severe pain
• Adult: IM/SUBCUT 50-100 mg 30-90 min before surgery
Candidate age grouping · source pages 841, 842
Severe pain
• Adult: PO/IM/SUBCUT/IV Reduce dose by 25%-50% Renal dose
Candidate age grouping · source pages 841, 842
Severe pain
• Adult: PO/IM/SUBCUT/IV CCr 10-50 mL/min give 75% of dose; CCr <10 mL/ min give 50% of dose
Candidate age grouping · source pages 841, 842