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