Select a medication above to begin.
meperidine
generic
Black Box Warnings .
Appropriate Use
should only be prescribed by healthcare professionals knowledgeable about opioid use and how to mitigate associated risks; reserve opioid analgesics for patients with inadequate tx alternatives; not indicated for chronic pain tx; proper dosing and titration essential to decr. respiratory depression risk
Medication Error Risk
ensure accuracy when prescribing, dispensing, and administering meperidine oral solution; dosing errors due to confusion between mg and mL or different concentrations can result in accidental overdose and death
Addiction, Abuse, and Misuse
opioid agonist Schedule II controlled substance with risk of addiction, abuse, and misuse, which can lead to overdose and death; assess opioid abuse or addiction risk prior to prescribing; regularly reassess all patients for misuse, abuse, and addiction
Respiratory Depression
serious, life-threatening, or fatal cases may occur even with recommended use, especially during tx start or after dose incr; to decr. risk, initiate and titrate dose appropriately
Accidental Ingestion
accidental ingestion of even one dose, especially by children, can result in fatal meperidine overdose
Risks from Concomitant Use with Benzodiazepines, CNS Depressants
concomitant opioid use with benzodiazepines or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death; reserve concomitant use for patients with inadequate alternative tx options
Neonatal Opioid Withdrawal Syndrome
advise pregnant patients with extended opioid use of risk of potentially life-threatening neonatal opioid withdrawal syndrome; ensure tx by neonatology experts available at delivery
Opioid Analgesic REMS
providers are strongly encouraged to complete risk evaluation and mitigation strategy (REMS)-compliant education program, counsel patients and/or caregivers with each Rx on serious risks, safe use, and importance of reading medication guide
CYP450 3A4 Interaction
concomitant use with CYP450 3A4 inhibitors or D/C of concomitant CYP450 3A4 inducers may incr. meperidine concentration which may incr. or prolong adverse effects including potentially fatal respiratory depression; monitor patients receiving any concomitant CYP450 3A4 inhibitor or inducer
Risks from Concomitant Use with MAOIs
concomitant use with monoamine oxidase inhibitors (MAOIs) may result in coma, severe respiratory depression, cyanosis, and hypotension; use with MAOIs within the last 14 days is contraindicated
Adult Dosing .
Dosage forms: TAB: 50 mg, 100 mg; SOL: 10 mg per mL; INJ: various
Special Note
- [prescribing info]
- Info: consider prescribing opioid overdose reversal agent (e.g., naloxone, nalmefene), especially if risk of opioid overdose or accidental ingestion
pain, moderate-severe
- [50-150 mg PO/SC/IM/IV q3-4h prn]
- Max: 600 mg/day; Info: PO route not recommended; decr. dose if given IV, dilute prior to use, administer slowly; use lowest effective dose, shortest effective tx duration; incr. risk of excitatory neurotoxicity, seizure if dose >600 mg/24h or duration >48h; use lower doses in elderly patients; taper dose gradually to avoid withdrawal symptoms if D/C tx in physically opioid-dependent patients; search 'opioid taper' for epocrates Opioid Tapering decision tool
preoperative sedation
- [50-100 mg SC/IM x1]
- Start: 30-90min before anesthesia; Info: use lower doses in elderly patients
analgesia, obstetric
- [50-100 mg SC/IM q1-3h prn]
- Info: use lowest effective dose, shortest effective tx duration
shivering, postop (off-label)
- [12.5-50 mg IV x1]
- Alt: 0.4-0.5 mg/kg/dose IV x1; Info: use lower doses in elderly patients
renal dosing
- [pain or obstetric analgesia]
- renal impairment: avoid use
- HD/PD: avoid use
- [preoperative sedation or shivering]
- renal impairment: avoid use; Alt: CrCl 10-50: decr. usual dose by 25%; CrCl <10: decr. usual dose by 50%; Info: incr. risk of neurotoxic metabolite accumulation with repeat dosing
- HD/PD: avoid use
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised; Info: titrate slowly
Peds Dosing .
- Dosage forms: TAB: 50 mg, 100 mg; SOL: 10 mg per mL; INJ: various
Special Note
- [prescribing info]
- Info: consider prescribing opioid overdose reversal agent (e.g., naloxone, nalmefene), especially if risk of opioid overdose or accidental ingestion
pain, moderate-severe
- [1.1-1.8 mg/kg/dose PO/SC/IM/IV q3-4h prn]
- Max: 100 mg/dose; Info: PO route not recommended; decr. dose if given IV, dilute prior to use, administer slowly; use lowest effective dose, shortest effective tx duration; incr. risk of excitatory neurotoxicity, seizure if dose >600 mg/24h or duration >48h; taper dose gradually to avoid withdrawal symptoms if D/C tx in physically opioid-dependent patients; search 'opioid taper' for epocrates Opioid Tapering decision tool
preoperative sedation
- [1.1-2.2 mg/kg/dose SC/IM x1]
- Start: 30-90min before anesthesia; Max: 100 mg/dose
renal dosing
- [pain]
- renal impairment: avoid use
- HD/PD: avoid use
- [preoperative sedation]
- renal impairment: avoid use; Alt: CrCl 10-50: decr. usual dose by 25%; CrCl <10: decr. usual dose by 50%; Info: incr. risk of neurotoxic metabolite accumulation with repeat dosing
- HD/PD: avoid use
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised; Info: titrate slowly