Meperidine

1. Indications
   1. Other Narcotic Analgesics are preferred
      1. See disadvantages below (e.g. accumulation)
      2. Consider when only 1-2 doses required
   2. Effective in rigors
2. Pharmacokinetics
   1. Onset: 10 to 15 minutes
   2. Peak: 30 to 50 minutes
   3. Duration: 2 to 4 hours
3. Dosing: Child
   1. Dose: 0.25-1.0 mg/kg IV or IM q3-4 hours
4. Dosing: Adult
   1. Dose: 75 to 100 mg (1-1.5 mg/kg) IV q2-3 hours
      1. Dose per weight (default dosing often too low)
      2. Intravenous dosing preferred over intramuscular
         1. No dosing adjustment needed for IV versus IM
      3. Dosing frequency is often dosed too infrequently
         1. Duration of action is only 3 hours
      4. Avoid more than 2-3 doses due to accumulation
   2. Often administered with Hydroxyzine (Vistaril)
      1. Vistaril 25 to 50 mg (0.5 mg/kg) IM q4-6 hours
      2. Vistaril no longer routinely recommended
         1. Does not potentiate Meperidine
         2. Vistaril requires intramuscular dosing (sclerosing)
         3. Only indicated for Meperidine induced Nausea (20%)
      3. Consider alternative intravenous Antiemetic
         1. Example: Phenergan
         2. Dose only as needed for Nausea or Emesis
5. Disadvantages when compared with other Narcotics
   1. Toxic metabolites
      1. Neurotoxic metabolites (e.g. Seizure risk)
      2. Clark (1995) J Emerg Med 13(6):797
   2. Weak Analgesic compared with other Narcotics
   3. Accumulates in Renal Failure (avoid in the elderly)
   4. Psychomimetic effects (Dysphoria or Euphoria)
   5. Poor oral absorption