II. Indications

  1. Other Narcotic Analgesics are preferred
    1. See disadvantages below (e.g. accumulation)
    2. Consider when only 1-2 doses required
  2. Suppresses rigors and shivering
    1. Amphotericin
    2. Therapeutic Hypothermia

III. Pharmacokinetics

  1. Onset: 10 to 15 minutes
  2. Peak: 30 to 50 minutes
  3. Duration: 2 to 4 hours

IV. Dosing: Child

  1. Dose: 0.25-1.0 mg/kg (up to 1.8 mg/kg has been used max: 100 mg) IM q3-4 hours

V. Dosing: Adult

  1. Dose: 50 to 100 mg (or 1-1.5 mg/kg) IM q3-4 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

VI. Disadvantages

  1. Toxic metabolites
    1. Neurotoxic metabolites (e.g. Seizure risk)
    2. Clark (1995) J Emerg Med 13(6):797 [PubMed]
  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

VII. Advantages

  1. Serotonin reuptake inhibitor
  2. Suppresses rigors and shivering
    1. Amphotericin
    2. Therapeutic Hypothermia

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Cost: Medications

meperidine (on 5/18/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
MEPERIDINE 100 MG TABLET Generic $1.11 each
MEPERIDINE 100 MG/ML VIAL Generic $1.30 per ml
MEPERIDINE 50 MG TABLET Generic $0.73 each
MEPERIDINE 50 MG/5 ML SOLUTION Generic $0.18 per ml
demerol (on 2/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
DEMEROL 100 MG/ML AMPUL $3.07 per ml
DEMEROL 50 MG/ML AMPUL $3.22 per ml

Ontology: Meperidine (C0025376)

Definition (NCI) A synthetic piperidine ester with opioid analgesic activity. Meperidine mimics the actions of endogenous neuropeptides via opioid receptors, thereby producing the characteristic morphine-like effects on the mu-opioid receptor, including analgesia, euphoria, sedation, respiratory depression, miosis, bradycardia and physical dependence.
Definition (MSH) A narcotic analgesic that can be used for the relief of most types of moderate to severe pain, including postoperative pain and the pain of labor. Prolonged use may lead to dependence of the morphine type; withdrawal symptoms appear more rapidly than with morphine and are of shorter duration.
Definition (CSP) synthetic narcotic analgesic used where a relatively short duration of analgesia is desired; abuse of this drug may lead to dependence.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D008614
SnomedCT 387298007, 54544005
LNC LP16184-1, MTHU005014
English Isonipecain, Meperidine, Pethidine, 4-Piperidinecarboxylic acid, 1-methyl-4-phenyl-, ethyl ester, Meperidine [Chemical/Ingredient], pethidine, meperidine, MEPERIDINE, Meperidine (product), Meperidine (substance)
Swedish Meperidin
Czech meperidin
Finnish Petidiini
Japanese メペリジン, イソニペカイン, ペチジン
Italian Petidina, Meperidina
Polish Dolantyna, Meperydyna, Petydyna
Spanish meperidina (producto), meperidina (sustancia), meperidina, petidina, Meperidina, Petidina, Isonipecaína
French Péthidine
German Isonipecain, Meperidin, Pethidin
Portuguese Isonipecaína, Meperidina, Petidina

Ontology: Demerol (C0935966)

Definition (CHV) brand name of a strong pain medicine
Definition (CHV) brand name of a strong pain medicine
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D008614
English demerol, demerol [brand name], Demerol