Dangerous Drug: Meperidine Hydrochloride (Pethidine)(me per’ i deen)
Demerol, Meperitab
PREGNANCY CATEGORY C
PREGNANCY CATEGORY D
(PROLONGED USE)
CONTROLLED SUBSTANCE C-II
Drug class
Opioid agonist analgesic
Therapeutic Actions
Acts as agonist at specific opioid receptors in the CNS to produce analgesia, euphoria, sedation; the receptors mediating these effects are thought to be the same as those mediating the effects of endogenous opioids (enkephalins, endorphins).
Indications
Oral, parenteral: Relief of moderate to severe acute pain
Parenteral: Preoperative medication, support of anesthesia, and obstetric analgesia
NEW INDICATION: Unlabeled uses: Postoperative sweating, reduction in rigors from amphotericin B
Contraindications and Cautions
Contraindicated with hypersensitivity to opioids, diarrhea caused by poisoning (before toxins are eliminated), bronchial asthma, COPD, cor pulmonale, respiratory depression, anoxia, kyphoscoliosis, acute alcoholism, increased intracranial pressure, pregnancy, seizure disorder, renal impairment, concurrent MAOI use.
Contraindicated in premature infants.
Use cautiously with acute abdominal conditions, CV disease, supraventricular tachycardias, myxedema, delirium tremens, cerebral arteriosclerosis, ulcerative colitis, fever, Addison disease, prostatic hypertrophy, urethral stricture, recent GI or GU surgery, toxic psychosis, labor or delivery (opioids given to the mother can cause respiratory depression of neonate; premature infants are especially at risk), renal or hepatic impairment, lactation.
Available Forms
Tablets—50, 100 mg; syrup—50 mg/5 mL; injection—10, 25, 50, 75, 100 mg/mL; oral solution—50 mg/5 mL
Dosages
Do not use for longer than 2 days because of risk of neurotoxicity.
Adults
Relief of pain: Individualize dosage; 50–150 mg IM, subcutaneously, or PO every 3–4 hr as needed. Diluted solution may be given by slow IV injection. IM route is preferred for repeated injections.
Preoperative medication: 50–100 mg IM or subcutaneously, 30–90 min before beginning anesthesia.
Support of anesthesia: Dilute to 10 mg/mL, and give repeated doses by slow IV injection, or dilute to 1 mg/mL and infuse continuously. Individualize dosage.
Obstetric analgesia: When contractions become regular, 50–100 mg IM or subcutaneously; repeat every 1–3 hr.
Pediatric patients
Contraindicated in premature infants.
Relief of pain: 1.1–1.75 mg/kg IM, subcutaneously, or PO up to adult dose every 3–4 hr as needed. Maximum dose, 50–150 mg/dose.
Preoperative medication: 1.1–2.2 mg/kg IM or subcutaneously, up to adult dose, 30–90 min before beginning anesthesia.
Geriatric or debilitated patients
Use caution; respiratory depression may occur in elderly, the very ill, and those with respiratory problems. Reduced dosage may be needed.
Patients with renal impairment
Reduce dose with severe renal impairment: for CrCl of 10–50 mL/min, give 75% of normal dose; for CrCl of less than 10 mL/min, give 25%–50% of normal dose. Not recommended for patients on dialysis.
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