Action
Binds with opiate receptors in the CNS, altering both perception of and emotional response to pain through and unknown mechanism.
Route
PO, IV, IM, SC
Onset
PO 15 minutes, IV 1 minute, IM 10-15 minutes, SC 10-15 minutes
Peak
PO 1-1.5 hours, IV 5-7 minutes, IM 30-50 minutes, SC 30-50 minutes
Duration
2-4 hours with all routes
Dosage
Adults: 50-150mg PO, IM or SC every 3-4 hours as needed. IV injections of fractional doses (10mg/ml) alternatively, continuous IV infusion of a more dilute solution (1mg/ml) titrated to patient's needs.
Adverse Reactions
Sedation, somnolence, clouded sensorium, euphoria, paradoxical excitement, tremor, dizziness, seizures (with large doses), headache, hallucinations, syncope, lightheadedness, hypotension, bradycardia, tachycardia, cardiac arrest, shock, constipation, ileus, dry mouth, nausea, vomiting, biliary tract spasms, urine retention, respiratory depression, depression, respiratory arrest, pruritus, urticaria, diaphoresis, physical dependence, muscle twitching, phlebitis after IV delivery, local tissue irritation and induration after SC injection.
Interactions
Drug-Drug
Aminophylline, barbiturates, heparin, methicillin, morphine, phenytoin, sodium bicarbonate, sulfonamides: incompatible when mixed in the same IV container.
CNS depressants, general anethetics, hypnotics, other narcotic analgesics, phenothiazines, sedatives, tricyclic antidepressants: possible respiratory depression, hypotension, profound sedation, or coma. Use together with extreme caution. Reduce meperidine dosage.
MAO Inhibitors: increased CNS excitation or depression that can be severe or fatal. Don't use together.
Phenytoin: decreased blood levels of meperidine. Monitor for decreased analgesia.
Drug-Lifestyle
Alcohol use: additive effects. Use together cautiously.
Contraindications
Contraindicated in patients with hypersensitivity to drug and in those who have received MAO inhibitors within past 14 days.
Considerations
Use with extreme caution in patients with increased intracranial pressure, head injury, asthma, and other respiratory conditions; in supraventricular tachycardias, seizures, acute abdominal conditions, hepatic or renal disease, hypothyroidism, Addison's disease, urethral stricture, and prostatic hyperplasia; and in elderly of debilitated patients.
May be used in some patients allergic to morphine.
Keep narcotic antagonist (Narcan) available when giving IV.
SC injection is not recommended because it is very painful. However, it may be suitable for occasional use.
Oral dose is less than half as effective as parenteral dose. Give IM if possible. When changing from parenteral to oral route, know that dosage should be increased.
Syrup has local anesthetic effect. Give with full glass of water.
Meperidine and its active metabolite normeperidine accumulate in the body. Monitor for increased toxic effect, especially in patients with impaired renal function.
Because meperidine toxicity often appears after several days of treatment this drug is not recommended for treatment of chronic pain.
Watch for withdrawal symptoms if drug is discontinued abruptly after long term use.
Avoid alcohol
Avoid driving and other potentially hazardous activities that require mental alertness until drug's CNS effects are known.