meperidine hydrochloride

meperidine hydrochloride (pethidine hydrochloride)

Demerol, Meperitab

Pharmacologic class: Opioid agonist

Therapeutic class: Analgesic, adjunct to anesthesia

Controlled substance schedule II

Pregnancy risk category C

Action

Binds to and depresses opiate receptors in spinal cord and CNS, altering perception of and response to pain

Availability

Injection: 10 mg/ml, 25 mg/ml, 50 mg/ml, 75 mg/ml, 100 mg/ml

Oral solution: 500 mg/5 ml

Syrup: 50 mg/5 ml

Tablets: 50 mg, 100 mg

Indications and dosages

➣ Moderate to severe pain

Adults: 50 to 150 mg P.O., I.M., or subcutaneously q 3 to 4 hours as needed

Children: 1.1 to 1.8 mg/kg P.O., I.M., or subcutaneously q 3 to 4 hours, not to exceed 100 mg/dose

➣ Preoperative sedation

Adults: 50 to 100 mg I.M. or subcutaneously 30 to 90 minutes before anesthesia

Children: 1 to 2.2 mg/kg I.M. or subcutaneously 30 to 90 minutes before anesthesia. Don't exceed adult dosage.

➣ Support of anesthesia

Adults: Fractional doses (such as 10 mg/ml) by repeated slow I.V. injections or continuous I.V. infusion of a more dilute solution (such as 1 mg/ml). Dosages should be individualized.

➣ Analgesia during labor

Adults: 50 to 100 mg I.M. or subcutaneously when contractions are regular. May repeat q 1 to 3 hours.

Contraindications

• Hypersensitivity to drug or bisulfites (with some injectable products)

• MAO inhibitor use within past 14 days

Precautions

Use cautiously in:

• head trauma; increased intracranial pressure (ICP); severe renal, hepatic, or pulmonary disease; hypothyroidism; adrenal insufficiency; extensive burns; alcoholism; supraventricular tachycardia; seizure disorders

• undiagnosed abdominal pain or prostatic hyperplasia

• elderly or debilitated patients

• pregnant patients (not recommended before labor)

• labor (drug may cause respiratory depression in neonate)

• breastfeeding patients

• children.

Administration

• Give I.M. injection slowly into large muscle. Preferably, use diluted solution.

• Give oral solution or syrup in a half-glass of water to avoid topical anesthetic effect on mucous membranes.

• Be aware that drug is compatible with 5% dextrose and lactated Ringer's solution, dextrose-saline solution combinations, and 2.5%, 5%, or 10% dextrose in water.

See Know that drug is not compatible with soluble barbiturates, aminophylline, heparin, morphine sulfate, methicillin, phenytoin, sodium bicarbonate, iodide, sulfadiazine, or sulfisoxazole.

• Don't give for chronic pain control, because of potential toxicity and dependence.

Adverse reactions

CNS: confusion, sedation, dysphoria, euphoria, floating feeling, hallucinations, headache, unusual dreams, seizures

CV: hypotension, bradycardia, cardiac arrest, shock

EENT: blurred vision, diplopia, miosis

GI: nausea, vomiting, constipation, ileus, biliary tract spasms

GU: urinary retention

Respiratory: respiratory depression, respiratory arrest

Skin: flushing, sweating, induration

Other: pain at injection site, local irritation, physical or psychological drug dependence, drug tolerance

Interactions

Drug-drug. Antihistamines, sedative-hypnotics: additive CNS depression

Barbiturates, cimetidine, protease inhibitor antiretrovirals: increased respiratory and CNS depression

Chlorpromazine, thioridazine: increased risk of meperidine toxicity

MAO inhibitors, procarbazine: potentially fatal reaction

Opioid agonist-antagonists: precipitation of opioid withdrawal in physically dependent patients

Phenytoin: increased meperidine metabolism and decreased effects

Drug-diagnostic tests. Amylase, lipase: increased levels

Drug-herbs. Chamomile, hops, kava, skullcap, valerian: increased CNS depression

Drug-behaviors. Alcohol use: increased CNS depression

Patient monitoring

See Monitor vital signs. Don't give drug if patient has significant respiratory or CNS depression.

• Reassess patient's pain level after administration.

See Watch for seizures, agitation, irritability, nervousness, tremors, twitches, and myoclonus in patients at risk for normeperidine accumulation (such as those with renal or hepatic impairment).

See Use with extreme caution in patients with head injury. Drug may increase ICP and cause adverse reactions that obscure clinical course.

• Closely monitor patients with acute abdominal pain. Drug may obscure diagnosis and clinical course of GI condition.

• Evaluate bowel and bladder function.

• With long-term or repeated use, watch for psychological and physical drug dependence and tolerance.

See With pediatric patients, stay alert for increased risk of seizures.

Patient teaching

• Tell patient using oral solution or syrup to take drug with a half-glass of water to minimize local anesthetic effect.

• Caution patient to avoid driving and other hazardous activities, because drug may cause dizziness or drowsiness.

• Advise patient to avoid alcohol.

• Instruct ambulatory patient to change position slowly to avoid orthostatic hypotension.

• Tell female patient to inform prescriber if she is pregnant or breastfeeding.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.