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meperidine hydrochloride (pethidine hydrochloride)
Pharmacologic class: Opioid agonist
Therapeutic class: Analgesic, adjunct to anesthesia
Controlled substance schedule II
Pregnancy risk category C
Binds to and depresses opiate receptors in spinal cord and CNS, altering perception of and response to pain
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.
• Hypersensitivity to drug or bisulfites (with some injectable products)
• MAO inhibitor use within past 14 days
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
• 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.
☞ 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.
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
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
☞ Monitor vital signs. Don't give drug if patient has significant respiratory or CNS depression.
• Reassess patient's pain level after administration.
☞ 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).
☞ 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.
☞ With pediatric patients, stay alert for increased risk of seizures.
• 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.
meperidineAn IV opioid analgesic with an active metabolite, normeperidine.
Potent blocker of pain messages to the brain.
Co-administration with MAOI antidepressants (may cause dizziness, lightheadedness, nausea); ritonavir.
2–5 hours for relief of moderate to severe pain.
200–800 ng/mL, meperidine; 130–480 ng/mL, normeperidine.
> 7 mg/L.
Random urine, serum.
Urine, TLC; serum, GC.