meperidine (Rx) - Demerol, pethidine

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosing Forms & Strengths

syrup: Schedule II

  • 50mg/5mL

tablet: Schedule II

  • 50mg
  • 100mg

injectable solution: Schedule II

  • 25mg/mL
  • 50mg/mL
  • 75mg/mL
  • 100mg/mL

Pain

Meperidine is not recommended as a first choice analgesic by The American Pain Society and ISMP (2007); if no other options, limit use in acute pain to ≤48hr; doses should not exceed 600 mg/24hr; oral route is not recommended for treatment of acute or chronic pain

Pain: 50-150 mg PO/IM/SC q3-4hr PRN; adjust dose based degree of response

Preoperatively: 50-150 mg IM/SC q3-4hr PRN

Continuous infusion: 15-35 mg/hr

Obstetrical analgesia: 50-100 mg IM/SC; repeated q1-3hr PRN

Dosing Modifications

Renal impairment: Avoid use

Hepatic impairment: Consider lower initial dose intially; increased opioid effect possible in cirrhosis

Dosing Forms & Strengths

syrup: Schedule II

  • 50mg/5mL

tablet: Schedule II

  • 50mg
  • 100mg

injectable solution: Schedule II

  • 25mg/mL
  • 50mg/mL
  • 75mg/mL
  • 100mg/mL

Pain

Meperidine is not recommended as a first choice analgesic by The American Pain Society and ISMP (2007); if no other options, limit use in acute pain to ≤48hr; doses should not exceed 600 mg/24hr; oral route is not recommended for treatment of acute or chronic pain

1-1.8 mg/kg PO/IM/SC q3-4hr PRN; individual dose not to exceed 100 mg  

Preoperatively: 1.1-2.2 mg/kg IM/SC 30-90 minutes before initiation of anesthesia

Pain

50 mg PO q4hr or 25 mg IM q4hr; treatment for acute pain should be limited to 1-2 doses

Dosing Considerations

Not drug of choice in elderly patients, because of accumulation of metabolite normeperidine, causing increased central nervous system (CNS) effects

Reduce total daily dose in elderly patients

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Drug Interactions

Interaction Checker

meperidine and

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Agitation

            Angina

            Bradycardia

            Cardiac arrest

            Coma

            Constipation

            Dizziness

            Dry mouth

            Dysphoria

            Euphoria

            Faintness

            Hypotension

            Mental clouding or depression

            Myocardial infarction

            Nausea

            Nervousness

            Palpitation

            Physical and psychological dependence

            Pruritus, urticaria

            QT-interval prolongation

            Respiratory arrest

            Respiratory/circulatory depression

            Restlessness

            Sedation

            Seizures

            Severe cardiac arrhythmias

            Shock

            ST-segment elevation

            Sweating, flushing, warmness of face/neck/upper thorax

            Syncope

            Tachycardia

            Urinary retention

            Visual disturbances

            Vomiting

            Weakness

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            Contraindications & Cautions

            Contraindications

            Hypersensitivity to drug or component of the formulation

            Severe respiratory insufficiency

            Within 14 days of taking MAO inhibitors

            Cautions

            Potential for tolerance and drug dependence

            Caution in acute abdominal conditions (may obscure diagnosis or clinical course of patient), pseudomembranous colitis, toxin-mediated diarrhea

            Narrow therapeutic index in certain patient populations, particularly in combination with CNS-depressant drugs

            Cardiac arrhythmias, drug abuse or dependence, emotional lability, gallbladder disease, head injury, increased intracranial pressure, benign prostatic hyperplasia, hepatic or renal impairment, seizures with epilepsy, urethral stricture, urinary tract surgery

            Use with caution in following conditions: Sickle cell anemia; pheochromocytoma; acute alcoholism; adrenocortical insufficiency (eg, Addison disease); CNS depression or coma; delirium tremens; debilitated patients; kyphoscoliosis associated with respiratory depression; myxedema or hypothyroidism; prostatic hypertrophy or urethral stricture; head trauma; billiary tract impairment; severe impairment of hepatic, pulmonary, or renal function; toxic psychosis

            Interaction with mixed agonist/antagonist opioid analgesics (eg, pentazocine, nalbuphine, butorphanol, buprenorphine) may precipitate withdrawal symptoms

            May cause less smooth muscle spasm and constipation than equipotent doses of morphine

            Chronic high-dose therapy or administration to patients with renal impairment may result in accumulation of active metabolite normeperidine, leading to agitation and seizures

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            Pregnancy & Lactation

            Pregnancy category: B; use for prolonged periods or near term not established

            Lactation: Drug excreted in breast milk

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Narcotic agonist-analgesic of opiate receptors; inhibits ascending pain pathways, thus altering response to pain; produces analgesia, respiratory depression, and sedation

            Absorption

            Bioavailability: 50-60%; hepatic impairment, 80-90%

            Onset: Rapid

            Duration: PO/SC, 2-4 hr

            Peak plasma time: SC, 40-60 min; IM, 30-50 min

            Distribution

            Protein bound: 65-75%

            Metabolism

            Metabolized in liver via hydrolysis, partial conjugation with glucuronic acid, N-demethylation

            Metabolites: Meperidinic acid, normeperidine (active)

            Elimination

            Half-life: 2.5-4 hr (adults); 7-11 hr (liver disease)

            Excretion: Urine (primarily)

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            IV & IM Information

            IV Incompatibilities

            Additive: Aminophylline, amobarbital, floxacillin, furosemide, heparin, morphine, phenobarbital, phenytoin, sodium bicarbonate(?)

            Syringe: Heparin, morphine, pentobarbital

            Y-site: Acyclovir(?), allopurinol, amphotericin B cholesteryl sulfate, cefepime, cefoperazone, doxorubicin, furosemide (may be compatible at lower concentrations), idarubicin, imipenem-cilastatin, minocycline, nafcillin(?)

            Not specified: Diazepam

            IV Compatibilities

            Solution: Most common solvents

            Additive: Cefazolin, dobutamine, metoclopramide, ondansetron, scopolamine, triflupromazine, verapamil

            Syringe: Atropine, butorphanol, chlorpromazine, cimetidine, dimenhydrinate, diphenhydramine, droperidol, fentanyl, glycopyrrolate, hydroxyzine, ketamine, metoclopramide, midazolam, ondansetron, papaveretum, pentazocine, pentazocine with perphenazine, perphenazine, prochlorperazine, promazine, promethazine, promethazine with atropine, ranitidine, scopolamine

            Y-site: Amifostine, amikacin, ampicillin, ampicillin-sulbactam, atenolol, aztreonam, bivalirudin, bumetanide, cefamandole, cefazolin, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftizoxime, ceftriaxone, cefuroxime, chloramphenicol, cisatracurium, cladribine, clindamycin, dexamethasone, dexmedetomidine, diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doxycycline, droperidol, erythromycin, etoposide phosphate, famotidine, fenoldopam, filgrastim, fluconazole, fludarabine, gatifloxacin, gemcitabine, gentamicin, granisetron, heparin, 6% hetastarch in lactated electrolyte injection (Hextend), hydrocortisone, insulin, kanamycin, labetalol, lidocaine, linezolid, magnesium sulfate, melphalan, methyldopate, methylprednisolone, metoclopramide, metoprolol, metronidazole, ondansetron, oxacillin, oxytocin, paclitaxel, penicillin G, piperacillin, piperacillin-tazobactam, potassium chloride, propofol, propranolol, ranitidine, remifentanyl, sargramostim, teniposide, thiotepa, ticarcillin, ticarcillin-clavulanate, tobramycin, trimethoprim, vancomycin, verapamil, vinorelbine

            Not specified: Epinephrine

            IV/IM Administration

            IM: Inject into large muscle mass; when repeated injection is needed, IM is preferred to SC

            IV injection: Inject 10 mg/mL very slowly; opiate antagonist and facilities for administration of oxygen and control of respiration should be available during and immediately after administration

            Continuous IV infusion: 15-35 mg/hr

            Drug has been injected or infused epidurally

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
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