Generic Name: Meperidine Hydrochloride
Class: Opiate Agonists
VA Class: CN101
CAS Number: 50-13-5
Introduction
Opiate agonist; a synthetic phenylpiperidine derivative.b
Uses for Demerol
Acute Pain
A strong analgesic used in the relief of moderate to severe pain.b
Usually, temporary relief of moderate to severe pain such as that associated with acute and some chronic medical disorders including renal or biliary colic, acute trauma, postoperative pain, and cancer.e
Used to provide analgesia during diagnostic and orthopedic procedures and during labor.246 e
For preoperative sedation and as a supplement to anesthesia.e
Around-the-clock dosing of analgesics may be considered in the initial stages of acute pain to avoid wide swings in pain and sedation often associated with as-needed dosing regimens.e
Although commonly used for acute pain relief, use as first-line opiate therapy is discouraged because of central excitatory toxicity of metabolite (normeperidine).247 245
Because of extensive first-pass metabolism in the liver to normeperidine, the risk of excitatory toxicity is increased with oral administration of meperidine; therefore, oral therapy is discouraged.246 247 245
Has been used to relieve the pain of MI, although probably not as effective as morphine sulfate.b
Chronic Pain
Use for chronic pain is discouraged because of short duration of effect and risk of accumulation of normeperidine metabolite and resultant central excitatory toxicity with repeated or large doses.e 248
Surgery
Used parenterally for preoperative sedation and as a supplement to anesthesia.b
Pulmonary Edema
Used in patients with acute pulmonary edema† for its cardiovascular effects and to allay anxiety.b
Do not use in the treatment of pulmonary edema resulting from a chemical respiratory irritant.b
Demerol Dosage and Administration
General
Give the smallest effective dose and as infrequently as possible to minimize the development of tolerance and physical dependence.b
Reduced dosage is indicated initially in poor-risk patients, in geriatric and very young patients, in patients with renal (particularly) or hepatic impairment, and in patients receiving other CNS depressants.b 246 247 245
Reduce meperidine dose by 25–50% when used in conjunction with other CNS depressants (e.g., phenothiazines, other tranquilizers); dosage adjustment for the concomitantly administered drug also may be necessary.b
Orally, 300 mg is approximately equianalgesic with 30 mg morphine sulfate.c 245 248 Parenterally, 75–100 mg is approximately equianalgesic with 10 mg morphine sulfate.c 245 248 (For specific patient dosages, see dosage recommendations in Dosage and also see Prescribing Limits under Dosage and Administration.)
Generally limit to short-term use (a few days) because of risk of accumulation of toxic normeperidine metabolite with repeated or large doses.e 247 245 248
Administration
Administer orally; by sub-Q, IM, or slow IV injection; or by slow, continuous IV infusion.b
Oral Administration
Least effective when given orally.b 246 247 245 Higher dosages may be necessary for pain relief, but the risk of toxicity from metabolite normeperidine is increased.247 248
Oral therapy is discouraged because of extensive first-pass metabolism in the liver and resultant increased formation of the toxic metabolite (normeperidine).246 247 245 248
Dilution
Dilute each dose of oral solution in ½ glassful of water, since undiluted solution may produce slight topical anesthesia on mucous membranes.b
IV Administration
Administer by direct IV injection, IV infusion, or IV via a controlled-delivery device for patient-controlled analgesia (PCA).b c 246
If IV administration is required, decrease dosage and administer injections very slowly, preferably as a 10-mg/mL injection.b HID
Alternatively, may use the commercially available injection containing 10 mg/mL intended for use with a compatible infusion device (does not require further dilution); this 10-mg/mL injection is for single use only, and unused portions should be discarded appropriately.b
When given parenterally, especially by the IV route, the patient should be lying down.b
During and immediately following IV administration, an opiate antagonist and facilities for administration of oxygen and control of respiration should be available.b
Dilution
May dilute in a compatible IV solution for infusion, usually to a concentration of 1 mg/mL.b HID (See Solution Compatibility under Compatibility.)
Rate of Administration
Direct IV injection: Usually, very slowly, preferably as a 10-mg/mL injection.246 HID
IV injection for PCA: Self-administered intermittently as needed (“prn”) via controlled-delivery device, with usual lockout intervals (minimum time between self-administered doses programmed into device) of 6–12 minutes.246
IV infusion, adults: Usually, 15–35 mg/hour.b
IM Administration
Inject into a large muscle mass, taking care to avoid nerve trunks.b
IM injection is discouraged for any analgesic (e.g., the injection itself is painful, delayed onset).246 247 248
When repeat parenteral doses are necessary and IV therapy is not used, IM is preferred over sub-Q administration because of occurrence of local tissue irritation and induration following sub-Q injection.b
Epidural Administration
Preservative-free injections have been injected or infused epidurally†; specialized techniques are required for administration of the drug by this route, and such administration should be performed only by qualified individuals familiar with the techniques of administration, dosages, and special patient management problems associated with epidural meperidine hydrochloride administration.b
Dosage
Pediatric Patients
Some experts discourage use in children.245
Usual Dosage
Oral, IM, or Sub-Q
May receive 1.1–1.8 mg/kg (up to adult dose) orally, IM, or sub-Q every 3–4 hours as needed.b c 246
Alternatively, 175 mg/m2 daily in 6 divided doses orally, IM, or sub-Q.b
Single pediatric doses should not exceed 100 mg.b
IV
Do not use for PCA when analgesic consumption is expected to be high; risk of CNS excitatory toxicity from normeperidine.247
PCA (usually IV) via controlled-delivery device: Loading doses of 0.5–1.5 mg/kg, preferably titrated by clinician or nurse at bedside.246
PCA (usually IV) via controlled-delivery device: Maintenance doses (administered intermittently) of 0.1–0.2 mg/kg, self-administered usually no more frequently than every 6–12 minutes as a device-programmed lockout period.246
Preoperative Dosage
IM or Sub-Q
May receive 1–2.2 mg/kg (maximum up to the adult dose) IM or sub-Q 30–90 minutes before the beginning of anesthesia.b
Adjunct to Anesthesia
IV Injection or IV Infusion
May be given by repeated slow IV injections of a dilute solution (e.g., containing 10 mg/mL) or by continuous IV infusion of a more dilute solution (e.g., containing 1 mg/mL).b
Adults
Usual Dosage
Oral, IM, or Sub-Q
Usually, 50–150 mg every 3–4 hours as needed.b c 246
IV infusion
Usually, 15–35 mg/hour.b
IV
Do not use for PCA when analgesic consumption is expected to be high; risk of CNS excitatory toxicity from normeperidine.247
PCA (usually IV) via controlled-delivery device: Loading doses of 12.5–25 mg every 10 minutes, preferably titrated by clinician or nurse at bedside, up to 50–125 mg total.246
PCA (usually IV) via controlled-delivery device: Maintenance doses (self-administered intermittently) of 5–10 mg, self-administered usually no more frequently than every 6–12 minutes as a device-programmed lockout period.246
Preoperative Dosage
IM or Sub-Q
Usually, 50–100 mg IM or sub-Q 30–90 minutes before the beginning of anesthesia.b
Adjunct to Anesthesia
IV Injection or IV Infusion
May be given by repeated slow IV injections of a dilute solution (e.g., containing 10 mg/mL) or by continuous IV infusion of a more dilute solution (e.g., containing 1 mg/mL).b
Analgesia during Labor
IM or Sub-Q
50–100 mg when labor pains become regular; repeat at 1- to 3-hour intervals as needed.b
Prescribing Limits
Pediatric Patients
Oral, IM, or Sub-Q
Single pediatric doses should not exceed 100 mg.b
Adults
Oral, IV, IM, or Sub-Q
Increased risk of toxicity from the active metabolite, normeperidine, when given for >48 hours or in total dosages exceeding 600 mg/24 hours.245 (See Elimination under Pharmacokinetics.)
Special Populations
Hepatic Impairment
Adjustment in the dose, frequency, and/or duration of therapy may be necessary because accumulation of the drug and/or its toxic metabolite, normeperidine, can occur.200 204 205 206 207 208 209 210 211 212 213
Certain adverse effects secondary to CNS stimulation (e.g., seizures, agitation, irritability, nervousness, tremors, twitches, myoclonus) have been attributed to accumulation of normeperidine.200 201 204 205 206 209 210 211 240
Oral bioavailability may be increased substantially in these patients.212 213 (See Pharmacokinetics.)
Renal Impairment
Generally avoid in renal impairment, particularly repeated or high doses.246 247 245
If used, adjustment in the dose, frequency, and/or duration of meperidine therapy is likely to be necessary because accumulation of the drug and/or its toxic metabolite, normeperidine, can occur.200 204 205 206 207 208 209 210 211 212 213
Certain adverse effects secondary to CNS stimulation (e.g., seizures, agitation, irritability, nervousness, tremors, twitches, myoclonus) have been attributed to accumulation of normeperidine.200 201 204 205 206 209 210 211 240
End-stage Renal Failure
Avoid because of the risk of accumulation of the toxic metabolite, normeperidine.200 205 207 208 211 220
Cautions for Demerol
Contraindications
Warnings/Precautions
Warnings
Shares the toxic potentials of the opiate agonists; observe the usual precautions of opiate agonist therapy.e
Serotonin Syndrome
Serotonin syndrome may occur in patients receiving MAO inhibitors in conjunction with other serotonergic drugs, including meperidine.
Concomitant use with an MAO inhibitor has resulted in excitatory effects (e.g., agitation, bizarre behavior, headache, hypertension, hypotension, rigidity, seizures, hyperpyrexia, coma) associated with serotonin syndrome.
Concomitant Use of Other CNS Depressants
Additive depressant effects may occur with concomitant use of other CNS depressants including other opiates, sedatives or hypnotics, general anesthetics, phenothiazines, tranquilizers, skeletal muscle relaxants, sedating antihistamines, and alcohol.e 244
When such combined therapy is contemplated, the dose of one or both agents should be reduced.b
Respiratory Depression
Causes dose-related respiratory depression.e 244
Respiratory depression is most common in geriatric or debilitated patients, or in conditions accompanied by hypoxia or hypercapnia; even moderate therapeutic opiate dosages may dangerously decrease pulmonary ventilation.e 244
Use with extreme caution, if at all, in anoxia, hypercapnia, respiratory depression, or in those who are especially prone to respiratory depression such as comatose patients or those with head injury, brain tumor, or elevated CSF pressure.e
Also use with extreme caution, if at all, in cor pulmonale, acute asthma exacerbation, or COPD and in others with substantially decreased respiratory reserve as in emphysema, hypoxia, hypercapnia, kyphoscoliosis, or severe obesity.e 244
Head Injury and Increased Intracranial Pressure
Respiratory depression effects and ability of opiates to increase CSF pressure may be markedly exaggerated in patients with head injury, other intracranial lesions, or preexisting elevation in intracranial pressure; opiate effects may produce cerebral hypoxia and obscure clinical course of patients with head injuries.244 Use with extreme caution, if at all.244
May interfere with evaluation of CNS function, and respiratory depression produced by the drug may produce cerebral hypoxia and elevated CSF pressure not caused by the injury itself.e 246
Ambulatory Patients
Performance of activities requiring mental alertness and physical coordination may be impaired (e.g., operating a motor vehicle or machinery).244
Hypotension
May cause severe hypotension postoperatively or when ability to maintain blood pressure is compromised (e.g., depleted blood volume, concurrent phenothiazine or general anesthetic use).244
May produce orthostatic hypotension in amubulatory patients.244
IM injection
Inadvertent IM injection into or near nerve trunks can result in sensory-motor paralysis, which may or may not be transient.b
Dependence
Physical and psychic dependence and tolerance may develop with repeated administration, and abuse potential exists; use with caution.e
Sensitivity Reactions
Sulfite Sensitivity
Some commercially available formulations contain sodium metabisulfite, a sulfite that may cause allergic-type reactions, including anaphylaxis and life-threatening or less severe asthmatic episodes, in certain susceptible individuals.b
Overall prevalence of sulfite sensitivity in the general population is unknown but probably low; such sensitivity appears to occur more frequently in asthmatic than in nonasthmatic individuals.b
General Precautions
Toxic Psychosis and Special Populations
Care should be exercised and the initial dosage of the opiate agonist should be reduced in patients with toxic psychosis and in geriatric or debilitated patients.e
Cardiac Arrhythmias
May increase ventricular response rate through a vagolytic action, therefore use with caution in patients with atrial flutter and other supraventricular tachycardias.b 244
Acute Abdominal Conditions
May obscure diagnosis or clinical course of patients with acute abdominal conditions.244
Seizure Risk
May aggravate preexisting seizure disorders.
Accumulation of toxic normeperidine metabolite can stimulate the CNS and precipitate seizures in patients without a preexisting seizure disorder.246 247 245 248
Normeperidine Accumulation
Use with caution in patients at risk for accumulation of normeperidine (e.g., those with renal or hepatic impairment) and during prolonged therapy and/or with high dosages in other patients (e.g., those with sickle cell anemia or CNS disease, burn patients, cancer patients) at risk for neurotoxic effects of the metabolite.200 204 205 206 207 208 209 210 211 212 213 220 240 245
Observe these patients closely for potential manifestations of CNS stimulation (e.g., seizures, agitation, irritability, nervousness, tremors, twitches, myoclonus) associated with accumulation of the metabolite.246 247 248 200 204 205 206 208 209 210 211 220 240
Specific Populations
Pregnancy
Category C.PDH
Lactation
Distributed into milk.246 244 Discontinue nursing or the drug.244
Pediatric Use
Should not be given to infants <6 months of age;PDH neonatal elimination is greatly reduced.246
Some experts discourage use in children of any age.245
Geriatric Use
Elimination is slower in geriatric patients than in younger patients.244
Geriatric patients, especially those with decreased renal and hepatic function, may be at greater risk for adverse CNS effects secondary to accumulation of the toxic metabolite normeperidine.242 243 244
Use with caution in geriatric patients, taking into account the potential risks and benefits to the patient, and dosage adjustment should be considered.246 242 243 244
Hepatic Impairment
Adjustment in the dose, frequency, and/or duration of therapy may be necessary because accumulation of the drug and/or its toxic metabolite, normeperidine, can occur.200 204 205 206 207 208 209 210 211 212 213 (See Hepatic Impariment under Dosage and Administration.)
Renal Impairment
Generally avoid in renal impairment, particularly repeated or high doses.246 247 245 (See Renal Impariment under Dosage and Administration.)
Common Adverse Effects
Adverse CNS effects include dizziness, visual disturbances, mental clouding or depression, sedation, coma, euphoria, dysphoria, weakness, faintness, agitation, restlessness, nervousness, seizures, and, rarely, delirium and insomnia.e
Adverse GI effects of opiate agonists include nausea, vomiting, and constipation.e
Opiate agonists may interfere with evaluation of CNS function, especially relative to consciousness levels, pupillary changes, and respiratory depression, thereby masking the patient’s clinical course.e
May increase the risk of water intoxication in postoperative patients because of stimulation of the release of vasopressin.e
Interactions for Demerol
Specific Drugs
Drug
|
Interaction
|
Comments
|
|---|
Amphetamines
|
Dextroamphetamine may enhance opiate agonist analgesiae
|
May be used to therapeutic advantage
|
Anticoagulants
|
Opiate agonists have been reported to potentiate the anticoagulant activity of coumarin anticoagulantse
|
|
Antidepressants, tricyclic
|
May potentiate the effects of tricyclic antidepressants e
|
Use concomitantly with caution; dosage adjustment may be necessarye
|
CNS depressants
|
May potentiate the effects of other CNS depressants including other opiates, general anesthetics, tranquilizers, sedatives and hypnotics, and alcohole
|
Use with great caution and in reduced dosage when used in conjunction with such drugs; some tranquilizers, especially phenothiazines, may antagonize opiate agonist analgesiae
|
Diuretics
|
Opiate agonists may decrease the effects of diuretics in patients with congestive heart failuree
|
|
Estrogens or estrogen-progestin combinations (oral contraceptives)
|
Oral contraceptives or estrogens may inhibit meperidine metabolism; clinical importance of this inhibition on analgesic effectiveness of meperidine has not been determinedb
|
|
Isoniazid
|
Concomitant use may aggravate the adverse effects of isoniazidb
|
|
MAO inhibitors
|
Therapeutic doses of meperidine concomitantly with an MAO inhibitor have produced coma, severe respiratory depression, cyanosis, and hypotension resembling the typical syndrome of acute opiate overdosage; these adverse effects may be associated with preexisting hyperphenylalaninemiab
Also, hyperexcitability and hypertension with concomitant useb
|
Meperidine is contraindicated in patients who have received an MAO inhibitor during the previous 14 daysb e
|
Skeletal muscle relaxants
|
May enhance the neuromuscular blocking action of skeletal muscle relaxantse
|
|
Demerol Pharmacokinetics
Absorption
Bioavailability
Oral: Undergoes extensive first-pass metabolism in the liver, with approximately 50–60% of a dose reaching systemic circulation unchanged.246 246 207 212 213 214
Oral: Bioavailability increases to approximately 80–90% in patients with hepatic impairment.212 213
Less than half as effective when given orally as when given parenterally.b 247
IM: Approximately 80–85% of a dose of the drug is absorbed within 6 hours after intragluteal injection.217
Onset
Oral, peak analgesia: Within 1 hour and declines gradually over 2–4 hours.b
Sub-Q, peak analgesia: In about 40–60.b
IM, peak analgesia: In about 30–50 minutes.b
Duration
Sub-Q or IM: Analgesia is maintained for 2–4 hours.b
Plasma Concentrations
Oral, peak: About 1 hour.246
IM, peak: Within 5–15 minutes..246
Distribution
Extent
Crosses the placenta; may accumulate in fetus.246 207 218
Distributes into breast milk.b 244
Plasma Protein Binding
Approximately 60–80%;246 212 principally albumin and α1-acid glycoprotein.246 212
Elimination
Metabolism
Principally in the liver.b 246
Normeperidine is the active metabolite and exhibits about half the analgesic potency of meperidine but twice the CNS stimulant (e.g., seizure-inducing) potency.200 201 202 203 204 205 206 207 208 209 210 211
Various toxic effects secondary to CNS stimulation (e.g., seizures, agitation, irritability, nervousness, tremors, twitches, myoclonus) have been attributed to accumulation of normeperidine.200 201 204 205 206 209 210 211 240
Elimination Route
Excreted in urine as metabolites and unchanged drug.b 246
Acidifying the urine enhances excretion of the unchanged drug and normeperidine.b
Half-life
Distribution phase half-life, meperidine: 2–11 minutes207 215 219
Terminal elimination half-life, meperidine: 3–5 hours.246 200 204 205 207 213 214 215 216 217 219
Terminal elimination half-life, normeperidine: Approximately 8–21 hours.246 200 204 205 207 208 210
Special Populations
Elimination half-life in hepatic dysfunction, meperidine: Prolonged.207
Cirrhosis207 213 215 or active viral hepatitis:207 216 Averages about 7–11 hours.b
Terminal elimination half-life in renal impairment, normeperidine: May be prolonged (e.g., 30–40 hours).200 204 205 207 208 210 211
Renal or hepatic impairment: Accumulation of normeperidine may occur with repeated, high doses of the drug.200 204 205 206 207 212 213 240
Stability
Storage
Protect from light and store at a temperature <40°C.b
Oral
Tablets
Well-closed containersb at 25°C (may be exposed to 15–30°C).244
Oral Solution
Tight containersb at 25°C (may be exposed to 15–30°C).244
Avoid freezing.b
Parenteral
Injection
15–25°C.b
Avoid freezing.b
Compatibility
For information on systemic interactions resulting from concomitant use, see Interactions.
Parenteral
Solution CompatibilityHID
Compatible
|
|---|
Dextran 6% in dextrose 5%
|
Dextran 6% in sodium chloride 0.9%
|
Dextrose–Ringer’s injection combinations
|
Dextrose–Ringer’s injection, lactated, combinations
|
Dextrose–saline combinations
|
Dextrose 2½, 4, 5, or 10% in water
|
Fructose 10% in sodium chloride 0.9%
|
Fructose 10% in water
|
Invert sugar 5 and 10% in sodium chloride 0.9%
|
Invert sugar 5 and 10% in water
|
Ionosol products
|
Ringer’s injection
|
Ringer’s injection, lactated
|
Sodium chloride 0.18, 0.45, or 0.9%
|
Sodium lactate (1/6) M
|
Drug Compatibility
Admixture CompatibilityHID
Compatible
|
|---|
Cefazolin sodium
|
Dobutamine HCl
|
Metoclopramide HCl
|
Ondansetron HCl
|
Scopolamine HBr
|
Succinylcholine chloride
|
Verapamil HCl
|
Incompatible
|
|---|
Aminophylline
|
Amobarbital sodium
|
Furosemide
|
Heparin sodium
|
Morphine sulfate
|
Phenobarbital sodium
|
Phenytoin sodium
|
Thiopental sodium
|
Variable
|
|---|
Sodium bicarbonate
|
Y-Site CompatibilityHID
Compatible
|
|---|
Amifostine
|
Amikacin sulfate
|
Ampicillin sodium
|
Ampicillin sodium–sulbactam sodium
|
Atenolol
|
Aztreonam
|
Bivalirudin
|
Bumetanide
|
Cefazolin sodium
|
Cefotaxime sodium
|
Cefoxitin sodium
|
Ceftazidime
|
Ceftizoxime sodium
|
Ceftriaxone sodium
|
Cefuroxime sodium
|
Chloramphenicol sodium succinate
|
Cladribine
|
Clindamycin phosphate
|
Co-trimoxazole
|
Dexamethasone sodium phosphate
|
Dexmedetomidine HCl
|
Digoxin
|
Diltiazem HCl
|
Diphenhydramine HCl
|
Dobutamine HCl
|
Docetaxel
|
Dopamine HCl
|
Doxycycline hyclate
|
Droperidol
|
Erythromycin lactobionate
|
Etoposide phosphate
|
Famotidine
|
Fenoldopam mesylate
|
Filgrastim
|
Fluconazole
|
Fludarabine phosphate
|
Gallium nitrate
|
Gemcitabine HCl
|
Gentamicin sulfate
|
Granisetron HCl
|
Heparin sodium
|
Hetastarch in lactated electrolyte injection (Hextend)
|
Hydrocortisone sodium succinate
|
Kanamycin sulfate
|
Labetalol HCl
|
Lidocaine HCl
|
Linezolid
|
Magnesium sulfate
|
Melphalan HCl
|
Methyldopate HCl
|
Methylprednisolone sodium succinate
|
Metoclopramide HCl
|
Metoprolol tartrate
|
Metronidazole
|
Ondansetron HCl
|
Oxacillin sodium
|
Oxytocin
|
Oxaliplatin
|
Paclitaxel
|
Pemetrexed disodium
|
Penicillin G potassium
|
Piperacillin sodium–tazobactam sodium
|
Potassium chloride
|
Propofol
|
Propranolol HCl
|
Ranitidine HCl
|
Remifentanil HCl
|
Sargramostim
|
Teniposide
|
Thiotepa
|
Ticarcillin disodium–clavulanate potassium
|
Tobramycin sulfate
|
Vancomycin HCl
|
Verapamil HCl
|
Vinorelbine tartrate
|
Incompatible
|
|---|
Allopurinol sodium
|
Amphotericin B cholesteryl sulfate complex
|
Cefepime HCl
|
Doxorubicin HCl liposome injection
|
Idarubicin HCl
|
Imipenem–cilastatin sodium
|
Lansoprazole
|
Variable
|
|---|
Acyclovir sodium
|
Furosemide
|
Nafcillin sodium
|
ActionsActions
Opiate agonists alter perception of and emotional response to pain.246
Precise mechanism of action has not been fully elucidated; opiate agonists act at several CNS sites, involving several neurotransmitter systems to produce analgesia.246
Pain perception is altered in the spinal cord and higher CNS levels (e.g., substantia gelatinosa, spinal trigeminal nucleus, periaqueductal gray, periventricular gray, medullary raphe nuclei, hypothalamus).246
Opiate agonists do not alter the threshold or responsiveness of afferent nerve endings to noxious stimuli, nor peripheral nerve impulse conduction.246
Opiate agonists act at specific receptor binding sites in the CNS and other tissues; opiate receptors are concentrated in the limbic system, thalamus, striatum, hypothalamus, midbrain, and spinal cord.246
Agonist activity at the opiate μ- or κ-receptor can result in analgesia, miosis, and/or decreased body temperature.246
Agonist activity at the μ-receptor can also result in suppression of opiate withdrawal (and antagonist activity can result in precipitation of withdrawal).246
Respiratory depression may be mediated by μ-receptors, possibly μ2-receptors (which may be distinct from μ1-receptors involved in analgesia); κ- and δ-receptors may also be involved in respiratory depression.246
Equianalgesic doses of meperidine hydrochloride and morphine sulfate produce the same degree of respiratory depression.b
Sedative and euphoric effects of equianalgesic doses of meperidine may be greater than those of morphine but reports are conflicting.b
Causes little or no constipation and has antitussive activity only in analgesic doses.b
Exhibits some anticholinergic properties.e
Systemic administration: May cause corneal anesthesia which can abolish the corneal reflex.b
Topical application: Produces considerable local anesthesia, but meperidine is not utilized for local anesthesia because it also produces local irritation.b
Overdosage may produce mydriasis rather than miosis.e
Toxic effects may be excitatory.e
Advice to Patients
Potential for drug to impair mental alertness or physical coordination; avoid driving or operating machinery until effects on individual are known.244
Advise patients of risk of postural hypotension during ambulation.244
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses.
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.
Importance of informing patients of other important precautionary information. (See Cautions.)
Preparations
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Meperidine hydrochloride preparations are subject to control under the Federal Controlled Substances Act of 1970 as schedule II (C-II) drugs.
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Meperidine Hydrochloride
Routes
|
Dosage Forms
|
Strengths
|
Brand Names
|
Manufacturer
|
|---|
Oral
|
Solution
|
50 mg/5 mL*
|
Demerol Hydrochloride Syrup ( C-II)
|
Sanofi-Aventis
|
|
|
|
Meperidine HCl Syrup ( C-II)
|
Roxane
|
|
Tablets
|
50 mg*
|
Demerol Hydrochloride ( C-II)
|
Sanofi-Aventis
|
|
|
100 mg*
|
Demerol Hydrochloride ( C-II)
|
Sanofi-Aventis
|
Parenteral
|
Injection
|
25 mg/mL*
|
Demerol Hydrochloride ( C-II; preservative-free in Carpuject cartridges)
|
Hospira
|
|
|
|
Meperidine HCl Injection ( C-II; preservative-free in ampuls and Tubex)
|
Baxter
|
|
|
50 mg/mL*
|
Demerol Hydrochloride ( C-II; preservative-free in ampuls and Carpuject cartridges or with metacresol 0.1% in multiple-dose vials)
|
Hospira
|
|
|
|
Meperidine HCl Injection ( C-II; with metacresol)
|
AstraZeneca
|
|
|
|
Meperidine HCl Injection ( C-II; preservative-free in ampuls and Tubex or with phenol and sodium metabisulfite in multiple-dose vials)
|
Baxter
|
|
|
75 mg/mL*
|
Demerol Hydrochloride ( C-II; preservative-free in Carpuject cartridges)
|
Hospira
|
|
|
|
Meperidine HCl Injection ( C-II; preservative-free in ampuls and Tubex)
|
Baxter
|
|
|
100 mg/mL*
|
Demerol Hydrochloride ( C-II; preservative-free in ampuls and Carpuject cartridges or with metacresol 0.1% in multiple-dose vials)
|
Hospira
|
|
|
|
Meperidine HCl Injection ( C-II; with metacresol)
|
AstraZeneca
|
|
|
|
Meperidine HCl Injection ( C-II; preservative-free in ampuls and Tubex or with phenol and sodium metabisulfite in multiple-dose vials)
|
Baxter
|
|
Injection, for IV infusion via compatible infusion devices only
|
10 mg/mL (300 mg)*
|
Meperidine HCl Injection ( C-II; preservative-free)
|
Hospira
|
Comparative Pricing
This pricing information is subject to change at the sole discretion of DS Pharmacy. This pr
