Meperidine (Injection)

Sold under the brand name Demerol, meperidine injection provides pain relief by acting on the central nervous system (CNS).

Overview

Meperidine injection belongs to a group of drugs called narcotic analgesics. It provides pain relief by acting on the central nervous system. The medication is commonly prescribed to manage moderate to severe pain in a hospital setting, before, or during a surgical, obstetrical, or dental procedure. Meperidine works very quickly and should begin to relieve pain within 10'15 minutes after administration. This medicine, however, should not be used for treating chronic pain.

Sold under the brand name Demerol, meperidine is injected into a vein, under the skin or deep into the muscle. When administered intravenously, meperidine should be injected slowly to prevent the development of serious side effects. If injected under the skin or into the muscle, it is important that the injection is administered at different locations to avoid developing problems under the skin. Like with other pain medications, meperidine works best when administered at the onset of the first signs of pain.

Meperidine is only available with a doctor's prescription and is available in solution form.

Conditions Treated By Meperidine

  • For the relief of moderate to severe pain
  • For preoperative medication
  • For support of anesthesia
  • For obstetrical analgesia

Type Of Medicine

  • Narcotic analgesic (pain medicine)

Meperidine side effects

Alongside the intended effects, meperidine does come with some unwanted effects. Some of these side effects are mild and tend to go away as the body adjusts to the medication. However, some meperidine side effects can be severe to the point of requiring medical attention.

Check with your healthcare provider immediately if you experience any of the following side effects while on meperidine treatment:

  • Blurred vision
  • Chest pain and discomfort
  • Bluish color
  • Cold, clammy skin
  • Changes in skin color
  • Convulsions
  • Confusion
  • Breathing difficulty
  • Dizziness, lightheadedness, or faintness when rising from a lying or sitting position
  • Fast, pounding, and irregular heartbeat
  • Face is warm or hot to touch
  • Fast or weak pulse
  • Pale or blue lips, skin, and fingernails
  • Pain
  • Redness of the face
  • Slow or irregular heartbeat
  • Profuse sweating
  • Shortness of breath
  • Shaking of the hands, legs, and lower feet
  • Swelling of the feet
  • Unconsciousness
  • Tenderness
  • Uncoordinated movement of the muscles
  • Upper abdominal or stomach pain
  • Unusual tiredness and general fatigue
  • Wheezing
  • Very slow breathing
  • Very slow pulse or blood pressure

Call your healthcare provider or the emergency room immediately if you experience any of the following meperidine overdose symptoms.

  • Pale or bluish skin or lips
  • Decreased responsiveness or awareness
  • Drifting in and out of consciousness
  • Sleepiness or unusual drowsiness

Some meperidine side effects may occur that do not require medical attention. These side effects are mild and will often go away as the body adjusts to the drug. Also, your healthcare professional should be able to advise you on how to prevent or reduce the severity of these side effects. However, you may check with your healthcare provider if any of the following meperidine side effects persist or become bothersome:

  • Nausea and vomiting
  • Drowsiness
  • Profuse sweating
  • Sleepiness
  • Relaxed and calm feeling
  • Anxiety
  • Confusion about time, location, or identity
  • Blurred vision
  • Constipation
  • Dry mouth
  • Trouble perceiving color
  • Double vision
  • Halos around lights
  • False sense of wellbeing
  • Hardening or thickening of the skin
  • Persistent headache
  • Hyperventilation
  • Irritability
  • Hives or welts
  • Itching of the skin
  • Night blindness
  • Nervousness
  • Red streaks on the skin
  • Overbright appearance of light
  • Restlessness
  • Shaking or tremors
  • General body weakness
  • Hallucinations
  • Skin rashes
  • Tunnel vision
  • Sleeping problems

Call your healthcare provider for advice about these side effects. You may also report the side effects to the FDA at 1-800-FDA-1088

Meperidine dosage

Dosing for pain relief

The dosage should be adjusted according to the severity of the pain as well as the patient's response to treatment. Subcutaneous dosage is suitable for occasional use; however, intramuscular administration is recommended when repeat dosage is required. If the medicine is administered intravenously, the dosage should be decreased and the injection made slowly using a diluted solution. The dosage should be proportionately reduced (usually by 25 to 50 percent) when concomitantly administered with phenothiazines or other tranquilizers since they potentiate the action of Meperidine.

Adult dosing:

Administer 50 mg to 150 mg subcutaneously or intramuscularly every 3 to 4 hours as necessary. Elderly patients should be given this medication at the lower end of the dose range and closely monitored.

Children

The recommended dosage should be 0.5 mg to 0.8 mg per kg body weight administered intravenously or subcutaneously every 3 to 4 hours as necessary.

For preoperative medication

Adult dosage

The average dosage is 50 mg to 100 mg administered subcutaneously or intramuscularly 30 to 90 minutes before the beginning of anesthesia. Elderly patients should be given the lower dose of this medication under close observation.

Children dosage

The recommended dosage is 0.5 mg to 1 mg per kilogram body weight administered subcutaneously or intramuscularly up to the adult dosage. This should be done 30 to 90 minutes before the onset of anesthesia.

Dosage For Supporting Anesthesia

Repeat slow intravenous injections of fractional doses (about 10 mg/mL) or a continuous intravenous infusion of a dilute solution. The dosage should be titrated to the patient's specific needs and depends on the premedication as well as anesthesia being employed, the patient's medical condition, as well as the nature and duration of the operative procedure. Elderly patients should be given lower doses of meperidine. In addition, they should be closely monitored while during the treatment period.

Dosage For Obstetrical Analgesia

The recommended dosage is 50 mg to 100 mg administered subcutaneously or intramuscularly to manage regular pain. This may be repeated at 1 to 3-hour intervals.

Missed Demerol damage

Because Meperidine should be taken on an as-needed basis, you do not have to worry about missing a dose. However, you should never double dose to make up for a skipped dose.

Demerol overdose

If you suspect Meperidine overdose, contact the emergency room immediately. You may also report overdose to the poison control center at 1-800-222-1222.

Meperidine interactions

Although certain medications should not be co-administered for fear of interactions, there are cases where two drugs may be prescribed together even if their combined use can cause an interaction. In such cases, your healthcare provider may recommend a change in dosage, times of use, or recommend other precautionary measures. Before starting meperidine treatment, inform your healthcare provider of any other medication you are taking including over the counter drugs, vitamins, supplements, as well as herbal medications.

That said, taking meperidine together with any of the following medications is not recommended, but may be necessary. If both drugs are prescribed together, your doctor may change the dosage or frequency with which you take one or both drugs.

  • Selegiline
  • Toloxatone
  • Tranylcypromine
  • Moclobemide
  • Naltrexone
  • Nialamide
  • Pargyline
  • Clorgyline
  • Iproniazid
  • Isocarboxazid
  • Linezolid
  • Phenelzine
  • Procarbazine
  • Rasagiline
  • Safinamide

Combining meperidine with any of the following medications may increase the risk of certain side effects even though the combination may offer the best treatment for your condition. If both drugs are recommended by your healthcare provider, be sure to ask how often you are to take both medications.

  • Alfentanil
  • Baclofen
  • Bromazepam
  • Bromopride
  • Amoxapine
  • Anileridine
  • Carbamazepine
  • Carbinoxamine
  • Carisoprodol
  • Chloral Hydrate
  • Butorphanol
  • Chlordiazepoxide
  • Chlorpheniramine
  • Clobazam
  • Clomipramine
  • Clonazepam
  • Clorazepate
  • Citalopram
  • Cocaine
  • Codeine
  • Buspirone
  • Butalbital
  • Chlorzoxazone
  • Buprenorphine
  • Cimetidine
  • Desipramine
  • Desvenlafaxine
  • Dextromethorphan
  • Dantrolene
  • Dezocine
  • Diazepam
  • Dibenzepin
  • Doxepin
  • Duloxetine
  • Eletriptan
  • Escitalopram
  • Donepezil
  • Estazolam
  • Flunitrazepam
  • Fluoxetine
  • Flurazepam
  • Fluvoxamine
  • Ethchlorvynol
  • Fentanyl
  • Flibanserin
  • Fospropofol
  • Granisetron
  • Halazepam
  • Hydrocodone
  • Furazolidone
  • Hydromorphone
  • Hydroxytryptophan
  • Ketazolam
  • Levomilnacipran
  • Levorphanol
  • Lithium
  • Lofepramine
  • Lorazepam
  • Meclizine
  • Medazepam
  • Melitracen
  • Methocarbamol
  • Methohexital
  • Methylene Blue
  • Methadone
  • Midazolam
  • Milnacipran
  • Morphine Sulfate Liposome
  • Nalbuphine
  • Naratriptan
  • Nefazodone
  • Mirtazapine
  • Morphine
  • Orphenadrine
  • Oxazepam
  • Oxycodone
  • Oxymorphone
  • Nortriptyline
  • Opipramol
  • Opium
  • Palonosetron
  • Periciazine
  • Prazepam
  • Propoxyphene
  • Protriptyline
  • Quazepam
  • Remifentanil
  • Sertraline
  • Sibutramine
  • Sodium Oxybate
  • St John's Wort
  • Paroxetine
  • Pentazocine
  • Rizatriptan
  • Sufentanil
  • Sumatriptan
  • Tapentadol
  • Tizanidine
  • Tramadol
  • Trazodone
  • Triazolam
  • Trimipramine
  • Vilazodone
  • Vortioxetine
  • Ziprasidone
  • Zolmitriptan
  • Almotriptan
  • Alprazolam
  • Amineptine
  • Amitriptyline
  • Amitriptylinoxide
  • Brompheniramine
  • Cyclobenzaprine
  • Dolasetron
  • Frovatriptan
  • Imipramine
  • Lorcaserin
  • Lormetazepam
  • Meperidine
  • Mephenesin
  • Mephobarbital
  • Meprobamate
  • Tianeptine
  • Tryptophan
  • Venlafaxine
  • Zolpidem
  • Meptazinol
  • Metaxalone
  • Nitrazepam
  • Temazepam

Combining meperidine with any of the following medications may increase the risk of certain side effects even though the combination may offer the best treatment for your condition. If both drugs are recommended by your healthcare provider, be sure to ask how often you are to take both medications.

  • Isoniazid
  • Mesoridazine
  • Phenytoin
  • Pipotiazine
  • Methotrimeprazine
  • Perphenazine
  • Acetophenazine
  • Chlorpromazine
  • Prochlorperazine
  • Ritonavir
  • Triflupromazine
  • Trimeprazine
  • Thiethylperazine
  • Thioridazine
  • Trifluoperazine
  • Ethopropazine
  • Fluphenazine
  • Fosphenytoin
  • Promazine
  • Promethazine
  • Propiomazine

Certain foods should not be taken while on some medications. Additionally, using alcohol and tobacco products while on some medications may cause an interaction. Specifically, you need to avoid alcohol while on meperidine treatment.

Certain pre-existing medical conditions may affect the efficiency of meperidine. Be sure to inform your healthcare provider if you have any of the following medical conditions before starting meperidine therapy.

  • Addison's disease (adrenal gland problem)
  • Severe asthma
  • A history of alcohol abuse
  • Severe breathing problems e.g hypoxia
  • Cor pulmonale (serious heart condition)
  • Chronic obstructive pulmonary condition
  • A history of drug dependence, especially with narcotics
  • A history of head injury
  • Enlarged prostate (BPH, prostate hypertrophy)
  • Problems passing urine
  • Hypothyroidism (an underactive thyroid)
  • Heart rhythm problems
  • Respiratory depression
  • Hypotension
  • Kidney disease
  • A history of seizures
  • Hypovolemia (low blood volume)
  • Liver disease

Meperidine and alcohol

Both meperidine and alcohol can cause nausea, dizziness, vomiting, and blurry vision. Drinking alcohol while on meperidine treatment can worsen the side effects, so try to avoid, or at least give up alcohol altogether while taking meperidine.

Meperidine and grapefruit juice

Do not eat grapefruits or drink grapefruit juice while taking meperidine. This is because grapefruit juice slows down how quickly the body is able to breakdown meperidine, which could trigger the dangerous rise of meperidine levels in your blood.

Meperidine warnings

Before you begin taking meperidine, be sure to inform your healthcare provider of any medical conditions or allergies you may be having. These should include drug, food, as well as animal allergies. Also, inform your doctor of any medications you are currently taking, including over the counter medications, vitamins, as well as herbal medications. It is also important that you mention whether you are pregnant or breastfeeding, as well as any other significant facts about your health as such facts may affect how you should take meperidine.

Abdominal conditions

Like other narcotic medications, long-term use of meperidine may make the diagnosis of abdominal conditions quite difficult. It may also worsen these conditions. If you have a history of abdominal conditions, be sure to discuss how this medication could affect your condition, the appropriate dosing, and whether you will need any special monitoring during the treatment period.

Asthma and other respiratory conditions

Meperidine can trigger breathing difficulty for patients with a chronic asthma attack or chronic obstructive pulmonary disease such as emphysema, chronic bronchitis, or other conditions that affect the breathing system. If you have asthma or any other breathing disorder, it is important that you discuss with your healthcare provider how meperidine will affect your condition, the appropriate dosing, and whether you will need any special monitoring during the treatment period.

Dependence and withdrawal

As with other narcotics, meperidine may become habit-forming if used for a long period. Thus, the patient may experience withdrawal symptoms if this medication is stopped abruptly. Such symptoms may include diarrhea, abdominal cramps, irritability, seizures, sleep problems, vomiting, agitation, headache, tremors, muscle cramps, tension, extreme anxiety, confusion, and profuse sweating. If you have been on a long meperidine treatment, consider stopping the medicine gradually if you no longer need it for pain control. Be sure to discuss the best way to stop meperidine with your healthcare provider.

Dizziness

Meperidine may cause dizziness when rising up from a lying or sitting position

Reduces alertness and drowsiness

Meperidine may impair your mental and physical abilities and affect your ability to safely perform certain tasks such as driving or operating dangerous machinery. It is important that you avoid these tasks, as well as other hazardous tasks until you fully determine how this medication affects you.

Head injuries

Meperidine can cause an increase in pressure to the head. If you have a history of acute head injury or other conditions that may increase intracranial pressure, it is important that you discuss with your healthcare provider how meperidine may affect your condition, appropriate dosing, as well as whether you may need special monitoring during the treatment period.

Kidney function

A build up of meperidine in the body may trigger kidney disease or reduce kidney function, resulting in side effects. If you have a history of kidney disease, be sure to discuss with your healthcare provider how meperidine will affect your condition, appropriate dosage, and whether you will require close monitoring during the treatment period.

Liver function

If you have a liver disease or reduced liver function, be sure to discuss with your healthcare provider how meperidine will affect your condition, appropriate dosage, and whether you will require close monitoring during the treatment period.

Other medical conditions

Meperidine may cause an increase in symptoms for patients with Addison's disease, hypothyroidism, urethral strictures, or enlarged prostate. If you have any of these conditions, be sure to discuss with your healthcare provider how meperidine will affect your condition, appropriate dosage, and whether you will require close monitoring during the treatment period.

Seizures

Meperidine can worsen pre-existing seizure disorders. If you have a history of seizure, be sure to discuss with your healthcare provider how meperidine will affect your condition, appropriate dosage, and whether you will require close monitoring during the treatment period.

Seniors on meperidine treatment

Seniors may be more sensitive to the side effects of meperidine, hence the need for lower doses. However, this meperidine should not be administered to seniors who:

  • Are allergic to this drug or any of its ingredients
  • Are suffering from obstructive airway infection, disease, or acute asthma
  • Have a history of acute alcoholism or delirium tremens
  • Have a blockage in the gastrointestinal tract, especially paralytic ileus
  • Suffer from acute respiratory depression
  • Have cor pulmonale
  • Have convulsive (seizure) disorders
  • Have a history of head injury or brain tumor
  • Have suspected abdominal condition which may require a surgical procedure
  • Have had an MAO inhibitor within the past 14 days
  • Have severe depression of the central nervous system (CNS)

Meperidine storage

Meperidine should be stored at room temperature (20 to 25 degrees C). Keep the medication away from pets and children in the original container to avoid accidental administration. Keep the medication away from direct sunlight, heat and moisture. Additionally, keep the medicine from freezing.

Do not flush the medication down the sink or toilet unless advised to do so. Consult your pharmacist on how to properly dispose of expired medications or medications that you no longer use.

Summary

Meperidine is a drug administered subcutaneously or intravenously to manage moderate to severe pain, help patients sleep before a surgical procedure, or provide pain relief during childbirth. Originally produced by Sanofi Aventis, the FDA first approved this medication for pain treatment in 1942. It is classified as a Schedule II (C-II) controlled substance.

Meperidine belongs to a class of pain medications called opioid analgesics. It works by binding the pain receptors on the surface of cells where opium normally binds, thus stopping the body from relaying pain signals to the brain.

Meperidine injection comes as a solution that is administered intramuscularly, intravenously, or subcutaneously. It is usually administered to manage pain once every 3 to 4 hours as needed. However, your healthcare provider may adjust your dosage depending on the condition you are treating, how effective the medication is at controlling pain, as well as the side effects developed during the treatment period.

If you have been on meperidine treat for longer than a few weeks, do not stop using the medicine abruptly as this might trigger withdrawal symptoms. On the contrary, your healthcare provider will help you decrease your dosage gradually.

Like with other medications, meperidine does come with its side effects. It is important that you look out for these side effects and discuss them with your healthcare provider. Be sure to report severe side effects like breathing difficulty and liver and kidney problems that may be life-threatening. Finally, be sure to use this medication exactly as directed by your healthcare provider.