| MEPERIDINE HYDROCHLORIDE
Demerol, Pethadol , Pethidine Hydrochloride
Classifications: narcotic (opiate) agonist analgesic; Therapeutic: narcotic analgesic
Pregnancy Category: B (D at term)
Controlled Substance: Schedule II
50 mg, 100 mg tablets; 50 mg/5 mL syrup; 10 mg/mL, 25 mg/mL, 50 mg/mL, 75 mg/mL, 100 mg/mL injection
Synthetic morphine-like compound. Opiates do not alter the pain threshold of afferent nerve endings, nor do they affect
the conductance of impulses along peripheral nerves. Analgesia is mediated through changes in the perception of pain at the
spinal cord (mu2, delta, kappa receptors) and higher levels in the CNS (mu1 and kappa3 receptors).
Control of moderate to severe pain.
Relief of moderate to severe pain, for preoperative medication, for support of anesthesia, and for obstetric analgesia.
Hypersensitivity to meperidine; convulsive disorders; acute abdominal conditions prior to diagnosis; MAOI therapy; pregnancy
prior to labor [(category C), at term (category D)].
Head injuries, increased intracranial pressure; asthma and other respiratory conditions; supraventricular tachycardias; prostatic
hypertrophy; urethral stricture; glaucoma; older adult or debilitated patients; impaired kidney or liver function, hypothyroidism,
Route & Dosage
|Moderate to Severe Pain
Adult: PO/SC/IM/IV 50150 mg q34h prn
Child: PO/SC/IM/IV 11.5 mg/kg q34h (max: ≤100 mg q4h) prn
Adult: IM/SC 50150 mg 3090 min before surgery
Child: IM/SC 1.12.2 mg/kg 3090 min before surgery
Adult: IM/SC 50100 mg when pains become regular, may be repeated q13h
Subcutaneous and Intramuscular Injections
- Give syrup formulation in half a glass of water. Undiluted syrup may cause topical anesthesia of mucous membranes.
- Be aware that SC route is painful and can cause local irritation. IM route is generally preferred when repeated doses are
- Aspirate carefully before giving IM injection to avoid inadvertent IV administration. IV injection of undiluted drug can
cause a marked increase in heart rate and syncope.
- Note: Verify correct IV concentration and rate of infusion/injection for administration to infants or children with physician.
PREPARE: Direct: Dilute 50 mg in at least 5 mL of NS or sterile water to yield 10 mg/mL. IV Infusion: Dilute to a concentration of 110 mg/mL in NS, D5W, or other compatible solution.
ADMINISTER: Direct: Give slowly over 35 min at a rate not to exceed 25 mg/min. Slower injection preferred. IV Infusion: Usually given through a controlled infusion device at a rate not to exceed 25 mg/min.
INCOMPATIBILITIES Solution/additive: Aminophylline, barbiturates, furosemide, heparin, methicillin, morphine, phenytoin, sodium bicarbonate. Y-site: Allopurinol, amphotericin B cholesteryl complex, cefepime, cefoperazone, doxorubicin liposome, furosemide, idarubicin, imipenem/cilastatin, mezlocillin, minocycline, tetracycline.
- Store at 15°30° C (59°86° F) in tightly closed, light-resistant containers unless otherwise
directed by manufacturer.
Adverse Effects (≥1%)Body as a Whole:
urticaria, skin rashes, wheal and flare over IV
site), profuse perspiration. CNS: Dizziness,
weakness, euphoria, dysphoria, sedation,
headache, uncoordinated muscle movements, disorientation, decreased cough reflex, miosis, corneal anesthesia, respiratory depression.
Toxic doses: muscle twitching, tremors, hyperactive reflexes, excitement, hypersensitivity to external stimuli, agitation,
confusion, hallucinations, dilated pupils, convulsions. CV:
Facial flushing, light-headedness, hypotension, syncope, palpitation, bradycardia, tachycardia, cardiovascular collapse, cardiac arrest (toxic doses). GI:
Dry mouth, nausea,
biliary tract spasm. Urogenital:
Oliguria, urinary retention. Respiratory: Respiratory depression in newborn, bronchoconstriction
(large doses). Skin:
Phlebitis (following IV
use), pain, tissue
irritation and induration, particularly following subcutaneous
Increased levels of serum
amylase, BSP retention, bilirubin
, AST, ALT.
Diagnostic Test Interference
High doses of meperidine may interfere with gastric emptying studies by causing delay in gastric emptying.
and other cns depressants
cause additive sedation and CNS
may potentiate CNS
stimulation; mao inhibitors
, selegiline, furazolidone
may cause excessive and prolonged CNS depression
, convulsions, cardiovascular collapse; phenytoin
may increase toxic meperidine metabolites. Herbal: St. John's wort
may increase sedation.
5060% from GI tract. Onset:
15 min PO; 10 min IM, SC; 5 min IV
1 h PO, IM, SC. Duration:
24 h PO, IM, SC; 2 h IV
Crosses placenta; distributed into breast milk. Metabolism:
In liver. Elimination:
In urine. Half-Life:
Assessment & Drug Effects
- Give narcotic analgesics in the smallest effective dose and for the least period of time compatible with patient's needs.
- Assess patient's need for prn medication. Record time of onset, duration, and quality of pain.
- Note respiratory rate, depth, and rhythm and size of pupils in patients receiving repeated doses. If respirations are 12/min
or below and pupils are constricted or dilated (see ACTIONS AND USES) or breathing is shallow, or if signs of CNS hyperactivity are present, consult physician before administering drug.
- Monitor vital signs closely. Heart rate may increase markedly, and hypotension may occur. Meperidine may cause severe hypotension
in postoperative patients and those with depleted blood volume.
- Schedule deep breathing, coughing (unless contraindicated), and changes in position at intervals to help to overcome respiratory
- Chart patient's response to drug and evaluate continued need.
- Repeated use can lead to tolerance as well as psychic and physical dependence of the morphine type.
- Be aware that abrupt discontinuation following repeated use results in morphine-like withdrawal symptoms. Symptoms develop
more rapidly (within 3 h, peaking in 812 h) and are of shorter duration than with morphine. Nausea, vomiting, diarrhea,
and pupillary dilatation are less prominent, but muscle twitching, restlessness, and nervousness are greater than produced
Patient & Family Education
- Do not smoke and walk without assistance after receiving the drug. Bed side rails may be advisable.
- Be aware nausea, vomiting, dizziness, and faintness associated with fall in BP are more pronounced when walking than when
lying down (these symptoms may also occur in patients without pain who are given meperidine). Symptoms are aggravated by
the head-up position.
- Do not drive or engage in potentially hazardous activities until any drowsiness and dizziness have passed.
- Do not take other CNS depressants or drink alcohol because of their additive effects.