Meperidine hydrochloride

Meperidine hydrochloride Brand Names- Demerol | Meperitab

What is Meperidine

Meperidine hydrochloride (known as pethidine outside the US) is a synthetic opiate agonist belonging to the phenylpiperidine class. Other members of this group include alfentanil, diphenoxylate, fentanyl, loperamide, and sufentanil. The chemical structure of meperidine is similar to local anesthetics.

Meperidine is a second-line agent for the treatment of moderate to severe acute pain and has the unique ability to interrupt postoperative shivering and shaking chills induced by amphotericin B.

Meperidine has also been used for peripheral nerve blocks and intraarticular, epidural, and spinal analgesia.

A high incidence of side effects limits the utility of meperidine in these situations.

Due to a short duration of action and a risk of seizures associated with the metabolite normeperidine, meperidine is not recommended for the treatment of chronic pain.

According to the Agency for Health Care Policy and Research Clinical Practice Guideline for acute pain management in operative or medical procedures and trauma, meperidine is recommended only for use in very brief courses in patients who are healthy and/or have problems with other opiate agonists.

In clinical practice, meperidine is commonly underprescribed in terms of dose and interval further limiting efficacy.

Meperidine is available in both oral and parenteral forms and was approved by the FDA and marketed in 1942.

Indications

1. general anesthesia maintenance
2. postoperative shivering
3. procedural sedation
4. severe pain
5. shaking chills

Side Effects

1. adrenocortical insufficiency
2. agitation
3. amenorrhea
4. anaphylactoid reactions
5. apnea
6. bradycardia
7. confusion
8. constipation
9. delirium
10. diaphoresis
11. dizziness
12. drowsiness
13. dysphoria
14. euphoria
15. flushing
16. gonadal suppression
17. hallucinations
18. headache
19. hyperamylasemia
20. hypertension
21. hyponatremia
22. hypotension
23. impotence (erectile dysfunction)
24. infertility
25. injection site reaction
26. libido decrease
27. muscle paralysis
28. myoclonia
29. nausea
30. neonatal opioid withdrawal syndrome
31. orthostatic hypotension
32. palpitations
33. phlebitis
34. physiological dependence
35. pruritus
36. psychological dependence
37. rash
38. respiratory arrest
39. respiratory depression
40. seizures
41. serotonin syndrome
42. SIADH
43. sinus tachycardia
44. syncope
45. tolerance
46. tremor
47. urinary retention
48. urticaria
49. visual impairment
50. vomiting
51. weakness
52. withdrawal
53. xerostomia

Monitoring Parameters

• laboratory monitoring not necessary

Contraindications

• abrupt discontinuation
• accidental exposure
• acute abdomen
• adrenal insufficiency
• alcoholism
• angina
• asthma
• atrial flutter
• biliary tract disease
• bladder obstruction
• breast-feeding
• cardiac arrhythmias
• cardiac disease
• children
• chronic obstructive pulmonary disease (COPD)
• CNS depression
• coadministration with other CNS depressants
• coma
• constipation
• cor pulmonale
• dehydration
• depression
• driving or operating machinery
• geriatric
• GI disease
• GI obstruction
• head trauma
• heart failure
• hepatic disease
• hypotension
• hypothyroidism
• hypovolemia
• hypoxemia
• ileus
• increased intracranial pressure
• infants
• infertility
• inflammatory bowel disease
• intracranial mass
• intravenous administration
• labor
• MAOI therapy
• myxedema
• neonatal opioid withdrawal syndrome
• neonates
• obesity
• obstetric delivery
• oliguria
• opioid overdose
• opioid use disorder
• orthostatic hypotension
• pancreatitis
• pheochromocytoma
• potential for overdose or poisoning
• pregnancy
• prostatic hypertrophy
• psychosis
• pulmonary disease
• renal disease
• renal failure
• renal impairment
• reproductive risk
• respiratory depression
• respiratory insufficiency
• scoliosis
• seizure disorder
• seizures
• shock
• sleep apnea
• status asthmaticus
• substance abuse
• ulcerative colitis
• urinary retention

Interactions

• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Dextromethorphan; Doxylamine
• Acetaminophen; Diphenhydramine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Pentazocine
• Acetaminophen; Tramadol
• Acrivastine; Pseudoephedrine
• Aldesleukin, IL-2
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Aliskiren; Hydrochlorothiazide, HCTZ
• Alosetron
• Alprazolam
• Alvimopan
• Amide local anesthetics
• Amifampridine
• Amiloride
• Amiloride; Hydrochlorothiazide, HCTZ
• Amitriptyline
• Amitriptyline; Chlordiazepoxide
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amobarbital
• Amoxapine
• Amphetamine
• Amphetamine; Dextroamphetamine
• Amphetamine; Dextroamphetamine Salts
• Anticholinergics
• Apomorphine
• Apraclonidine
• Aripiprazole
• Articaine; Epinephrine
• Asenapine
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Aspirin, ASA; Carisoprodol
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Oxycodone
• Atenolol; Chlorthalidone
• Atropine
• Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Atropine; Difenoxin
• Atropine; Diphenoxylate
• Atropine; Edrophonium
• Atropine; Hyoscyamine; Phenobarbital; Scopolamine
• Azelastine
• Azelastine; Fluticasone
• Azilsartan; Chlorthalidone
• Baclofen
• Barbiturates
• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Belladonna; Opium
• Benazepril; Hydrochlorothiazide, HCTZ
• Bendroflumethiazide; Nadolol
• Benzhydrocodone; Acetaminophen
• Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Benzonatate
• Benzphetamine
• Benztropine
• Bethanechol
• Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
• Bismuth Subsalicylate
• Bismuth Subsalicylate; Metronidazole; Tetracycline
• Bisoprolol; Hydrochlorothiazide, HCTZ
• Brexpiprazole
• Brimonidine
• Brimonidine; Brinzolamide
• Brimonidine; Timolol
• Brompheniramine
• Brompheniramine; Carbetapentane; Phenylephrine
• Brompheniramine; Dextromethorphan; Guaifenesin
• Brompheniramine; Dextromethorphan; Phenylephrine
• Brompheniramine; Guaifenesin; Hydrocodone
• Brompheniramine; Hydrocodone; Pseudoephedrine
• Brompheniramine; Pseudoephedrine
• Bumetanide
• Bupivacaine
• Bupivacaine Liposomal
• Bupivacaine; Lidocaine
• Buprenorphine
• Buprenorphine; Naloxone
• Bupropion
• Bupropion; Naltrexone
• Buspirone
• Butabarbital
• Butorphanol
• Candesartan; Hydrochlorothiazide, HCTZ
• Cannabidiol
• Capsaicin; Metaxalone
• Captopril; Hydrochlorothiazide, HCTZ
• Carbetapentane; Chlorpheniramine
• Carbetapentane; Chlorpheniramine; Phenylephrine
• Carbetapentane; Diphenhydramine; Phenylephrine
• Carbetapentane; Guaifenesin
• Carbetapentane; Guaifenesin; Phenylephrine
• Carbetapentane; Phenylephrine
• Carbetapentane; Phenylephrine; Pyrilamine
• Carbetapentane; Pseudoephedrine
• Carbetapentane; Pyrilamine
• Carbinoxamine
• Carbinoxamine; Dextromethorphan; Pseudoephedrine
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Hydrocodone; Pseudoephedrine
• Carbinoxamine; Phenylephrine
• Carbinoxamine; Pseudoephedrine
• Cariprazine
• Carisoprodol
• Cenobamate
• Cetirizine
• Cetirizine; Pseudoephedrine
• Chlophedianol; Dexbrompheniramine
• Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
• Chloral Hydrate
• Chlorcyclizine
• Chlordiazepoxide
• Chlordiazepoxide; Clidinium
• Chloroprocaine
• Chlorothiazide
• Chlorpheniramine
• Chlorpheniramine; Codeine
• Chlorpheniramine; Dextromethorphan
• Chlorpheniramine; Dextromethorphan; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Phenylephrine
• Chlorpheniramine; Pseudoephedrine
• Chlorpromazine
• Chlorthalidone
• Chlorthalidone; Clonidine
• Chlorzoxazone
• Cimetidine
• Cinacalcet
• Clemastine
• Clobazam
• Clomipramine
• Clonazepam
• Clonidine
• Clopidogrel
• Clorazepate
• Clozapine
• COMT inhibitors
• Crofelemer
• Cyclizine
• Cyclobenzaprine
• Cyproheptadine
• Dantrolene
• Darifenacin
• Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
• Delavirdine
• Desflurane
• Desipramine
• Desmopressin
• Deutetrabenazine
• Dexchlorpheniramine
• Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
• Dexmedetomidine
• Dexpanthenol
• Dextroamphetamine
• Dextromethorphan; Diphenhydramine; Phenylephrine
• Diazepam
• Dicyclomine
• Dimenhydrinate
• Diphenhydramine
• Diphenhydramine; Hydrocodone; Phenylephrine
• Diphenhydramine; Ibuprofen
• Diphenhydramine; Naproxen
• Diphenhydramine; Phenylephrine
• Dolasetron
• Doxepin
• Doxylamine
• Doxylamine; Pyridoxine
• Dronabinol
• Droperidol
• Eltrombopag
• Eluxadoline
• Enalapril; Hydrochlorothiazide, HCTZ
• Enflurane
• Eprosartan; Hydrochlorothiazide, HCTZ
• Esketamine
• Estazolam
• Eszopiclone
• Ethacrynic Acid
• Ethanol
• Ethotoin
• Etomidate
• Fenfluramine
• Fesoterodine
• Flavoxate
• Flibanserin
• Fluoxetine; Olanzapine
• Fluphenazine
• Flurazepam
• Fosinopril; Hydrochlorothiazide, HCTZ
• Fosphenytoin
• Fospropofol
• Furosemide
• Gabapentin
• General anesthetics
• Glycopyrrolate
• Glycopyrrolate; Formoterol
• Granisetron
• Guaifenesin; Hydrocodone
• Guaifenesin; Hydrocodone; Pseudoephedrine
• Guanabenz
• Guanfacine
• Haloperidol
• Halothane
• Homatropine; Hydrocodone
• Hydantoins
• Hydralazine; Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ; Irbesartan
• Hydrochlorothiazide, HCTZ; Lisinopril
• Hydrochlorothiazide, HCTZ; Losartan
• Hydrochlorothiazide, HCTZ; Methyldopa
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Moexipril
• Hydrochlorothiazide, HCTZ; Olmesartan
• Hydrochlorothiazide, HCTZ; Propranolol
• Hydrochlorothiazide, HCTZ; Quinapril
• Hydrochlorothiazide, HCTZ; Spironolactone
• Hydrochlorothiazide, HCTZ; Telmisartan
• Hydrochlorothiazide, HCTZ; Triamterene
• Hydrochlorothiazide, HCTZ; Valsartan
• Hydrocodone
• Hydrocodone; Ibuprofen
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Hydromorphone
• Hydroxyzine
• Hyoscyamine
• Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
• Ibuprofen; Oxycodone
• Iloperidone
• Imipramine
• Indacaterol; Glycopyrrolate
• Indapamide
• Isoflurane
• Isoniazid, INH
• Isoniazid, INH; Pyrazinamide, PZA; Rifampin
• Isoniazid, INH; Rifampin
• Ketamine
• Lasmiditan
• Lemborexant
• Levobupivacaine
• Levocetirizine
• Lidocaine
• Lidocaine; Prilocaine
• Lincosamides
• Linezolid
• Lisdexamfetamine
• Lithium
• Lofexidine
• Loop diuretics
• Loperamide
• Loperamide; Simethicone
• Lopinavir; Ritonavir
• Lorazepam
• Lorcaserin
• Loxapine
• Lumateperone
• Lurasidone
• Magnesium Salts
• Maprotiline
• Melatonin
• Mepenzolate
• Mephobarbital
• Mepivacaine
• Mepivacaine; Levonordefrin
• Meprobamate
• Mesoridazine
• Metaxalone
• Methadone
• Methamphetamine
• Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
• Methocarbamol
• Methohexital
• Methscopolamine
• Methyclothiazide
• Methyldopa
• Methylene Blue
• Methylphenidate
• Metoclopramide
• Metolazone
• Metyrapone
• Metyrosine
• Midazolam
• Minocycline
• Mirtazapine
• Molindone
• Monoamine oxidase inhibitors
• Nabilone
• Nalbuphine
• Naloxone
• Naltrexone
• Nefazodone
• Nesiritide, BNP
• Nitroglycerin
• Nortriptyline
• Octreotide
• Olanzapine
• Ombitasvir; Paritaprevir; Ritonavir
• Ondansetron
• Orphenadrine
• Oxazepam
• Oxybutynin
• Oxycodone
• Oxymorphone
• Ozanimod
• Paliperidone
• Palonosetron
• Papaverine
• Pegvisomant
• Pentazocine
• Pentazocine; Naloxone
• Pentobarbital
• Perampanel
• Perphenazine
• Perphenazine; Amitriptyline
• Phenobarbital
• Phenytoin
• Pimozide
• Pramipexole
• Pramlintide
• Prasugrel
• Pregabalin
• Prilocaine
• Prilocaine; Epinephrine
• Primidone
• Procaine
• Procarbazine
• Prochlorperazine
• Propantheline
• Propofol
• Protriptyline
• Quazepam
• Quetiapine
• Quinine
• Ramelteon
• Rasagiline
• Risperidone
• Ritodrine
• Ritonavir
• Ropinirole
• Ropivacaine
• Rotigotine
• Safinamide
• Scopolamine
• Secobarbital
• Selective serotonin reuptake inhibitors
• Selegiline
• Serotonin norepinephrine reuptake inhibitors
• Serotonin-Receptor Agonists
• Serotonin-Receptor Antagonists
• Sevoflurane
• Sibutramine
• Sildenafil
• Sodium Oxybate
• Solifenacin
• Spironolactone
• St. John’s Wort, Hypericum perforatum
• Suvorexant
• Tapentadol
• Tasimelteon
• Tedizolid
• Temazepam
• Terbinafine
• Tetrabenazine
• Tetracaine
• Thalidomide
• Thiazide diuretics
• Thiethylperazine
• Thiopental
• Thioridazine
• Thiothixene
• Ticagrelor
• Tipranavir
• Tizanidine
• Tolterodine
• Torsemide
• Tramadol
• Trazodone
• Triamterene
• Triazolam
• Tricyclic antidepressants
• Trifluoperazine
• Trihexyphenidyl
• Trimethobenzamide
• Trimipramine
• Triprolidine
• Trospium
• Valerian, Valeriana officinalis
• Valproic Acid, Divalproex Sodium
• Vigabatrin
• Vilazodone
• Vortioxetine
• Zaleplon
• Ziconotide
• Ziprasidone
• Zolpidem