Demerol (meperidine HCl)

Meperidine hydrochloride should be given at the lowest effective dosage and for the shortest duration of therapy consistent with the treatment goals of the patient.

Meperidine hydrochloride generally should be limited to short-term use (a few days) because of the risk of accumulation of the toxic normeperidine metabolite with repeated or large doses.

Reduced meperidine hydrochloride dosage is indicated in poor-risk patients and in very young or geriatric patients. If concomitant therapy with other CNS depressants is required, the lowest effective dosages and shortest possible duration of concomitant therapy should be used. In patients receiving phenothiazines or other tranquilizers concomitantly with meperidine, the dose of meperidine should be reduced by 25-50% since these drugs potentiate the adverse effects of meperidine.

The usual adult oral, IM, or subcutaneous dosage of meperidine hydrochloride is 50-150 mg every 3-4 hours as necessary. When the drug is administered by slow, continuous IV infusion, the usual adult dosage is 15-35 mg/hour. Patients receiving meperidine hydrochloride for longer than 48 hours or in total dosages exceeding 600 mg over 24 hours are at increased risk of toxicity from the normeperidine metabolite. (See Pharmacokinetics: Elimination.)

Children may receive 1.1-1.8 mg/kg orally, IM, or subcutaneously every 3-4 hours as necessary. Alternatively, children may receive 175 mg/m2 daily in 6 divided doses administered by the oral, IM, or subcutaneous route. Single pediatric doses should not exceed 100 mg.

The usual adult preoperative dose of meperidine hydrochloride is 50-100 mg IM or subcutaneously 30-90 minutes before the beginning of anesthesia. Children may receive 1-2.2 mg/kg (maximum up to the adult dose) IM or subcutaneously 30-90 minutes before the beginning of anesthesia. As a supplement to anesthesia, meperidine may be given by repeated slow IV injections of a dilute solution (e.g., containing 10 mg/mL) or by continuous IV infusion of a more dilute solution (e.g., containing 1 mg/mL).

To provide analgesia during labor, 50-100 mg of meperidine hydrochloride may be administered IM or subcutaneously when labor pains become regular. If necessary, this dose may be repeated at 1- to 3-hour intervals.

For further information on the management of opiate analgesic therapy, see Dosage and Administration: Dosage, in the Opiate Agonists General Statement 28:08.08.

Adjustment in the dose, frequency, and/or duration of meperidine therapy may be necessary in patients with hepatic impairment since accumulation of the drug and/or its active metabolite, normeperidine, can occur. In addition, oral bioavailability of meperidine may be increased substantially in patients with hepatic impairment. (See Pharmacokinetics.) Certain adverse effects secondary to CNS stimulation (e.g., seizures, agitation, irritability, nervousness, tremors, twitches, myoclonus) have been attributed to accumulation of normeperidine.

Because of the potential for accumulation of normeperidine in patients with renal impairment, use of meperidine, particularly high or repeated doses, generally should be avoided in these patients. If meperidine is used, adjustment of the dose, frequency, and/or duration of therapy is likely to be necessary. In patients with end-stage renal failure, meperidine should be avoided because of the risk of accumulation of this metabolite.

Meperidine hydrochloride is administered orally; by subcutaneous, IM, or slow IV injection; or by slow, continuous IV infusion. The drug is least effective when given orally.

Some experts discourage administration of meperidine hydrochloride by the oral route because of extensive first-pass metabolism in the liver and resultant increased formation of the toxic metabolite, normeperidine.

Each dose of the meperidine hydrochloride oral solution should be taken in one-half glassful of water, since the undiluted solution may produce slight topical anesthesia on mucous membranes.

IM administration of opiate analgesics is discouraged, since IM injections can cause pain and are associated with unreliable absorption, resulting in inconsistent analgesia. However, when repeat doses are necessary and IV therapy is not used, the IM route is preferred over subcutaneous administration because of occurrence of local tissue irritation and induration following subcutaneous injection.

When meperidine hydrochloride is administered IM, it should be injected into a large muscle mass, taking care to avoid nerve trunks.

If IV administration is required, meperidine dosage should be decreased and the commercially available injections should be administered very slowly, preferably as dilute solutions. Alternatively, the commercially available injection containing 10 mg/mL, which should be used only with a compatible infusion device and does not require further dilution, may be used; the 10-mg/mL injection is intended for single use only, and unused portions should be appropriately discarded. When meperidine is given parenterally, especially by the IV route, the patient should be lying down. An opiate antagonist and facilities for administration of oxygen and control of respiration should be available during and immediately following IV administration of the drug.

Preservative-free injections of meperidine hydrochloride have been injected or infused epidurally+; specialized techniques are required for administration of the drug by this route, and such administration should be performed only by qualified individuals familiar with the techniques of administration, dosages, and special patient management problems associated with epidural meperidine hydrochloride administration.

As with other parenteral products, meperidine hydrochloride injection should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.

No dosing information is available for this tab.

No dosing information is available for this tab.

There is no enhanced messaging for this drug.

There are no contraindication interactions for this drug.

There are no severe interactions for this drug.

There are no moderate interactions for this drug.

There is no enhanced messaging for this drug.

There are no contraindication contraindications for this drug.

There are no severe contraindications for this drug.

There are no moderate contraindications for this drug.

There is no enhanced messaging for this drug.

There are no severe adverse reactions for this drug.

There are no less severe adverse reactions for this drug.

No enhanced messaging available.

No enhanced messaging available.

No enhanced messaging available.

No enhanced messaging available.

No enhanced messaging available.