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Demerol
meperidine
Black Box Warnings .
Appropriate Use
should only be prescribed by healthcare professionals knowledgeable about opioid use and how to mitigate assoc. risks; reserve opioid analgesics for pts w/ inadequate tx alternatives; not indicated for chronic pain tx; proper dosing and titration essential to decr. resp. 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 w/ 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 pts for misuse, abuse, and addiction
Respiratory Depression
serious, life-threatening, or fatal cases may occur even w/ recommended use, esp. during tx start or after dose incr; to decr. risk, initiate and titrate dose appropriately
Accidental Ingestion
accidental ingestion of even one dose, esp. by children, can result in fatal meperidine overdose
Risks from Concomitant Use w/ Benzodiazepines, CNS Depressants
concomitant opioid use w/ benzodiazepines or other CNS depressants, incl. alcohol, may result in profound sedation, resp. depression, coma, and death; reserve concomitant use for pts w/ inadequate alternative tx options
Neonatal Opioid Withdrawal Syndrome
advise pregnant pts w/ extended opioid use of risk of potentially life-threatening neonatal opioid withdrawal syndrome; ensure tx by neonatology experts avail. at delivery
Opioid Analgesic REMS
providers are strongly encouraged to complete risk evaluation and mitigation strategy (REMS)-compliant education program, counsel pts and/or caregivers w/ each Rx on serious risks, safe use, and importance of reading medication guide
CYP450 3A4 Interaction
concomitant use w/ CYP450 3A4 inhibitors or D/C of concomitant CYP450 3A4 inducers may incr. meperidine conc. which may incr. or prolong adverse effects incl. potentially fatal resp. depression; monitor pts receiving any concomitant CYP450 3A4 inhibitor or inducer
Risks from Concomitant Use w/ MAOIs
concomitant use w/ monoamine oxidase inhibitors (MAOIs) may result in coma, severe resp. depression, cyanosis, and hypotension; use w/ MAOIs within the last 14 days is contraindicated
Adult Dosing .
Dosage forms: TAB: 50 mg, 100 mg; INJ (cartridge): 25 mg per mL, 50 mg per mL, 75 mg per mL, 100 mg per mL; INJ (pre-filled syringe): 25 mg per mL, 50 mg per mL, 75 mg per mL, 100 mg per mL; INJ (vial): various
Dosage Form Details
- [SOL form discontinued in US for this brand; see generic]
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: parenteral route preferred to PO route; decr. dose if given IV, dilute prior to use, admin. slowly; use lowest effective dose, shortest effective tx duration; incr. risk of excitatory neurotoxicity, seizure if dose >600 mg/24h SC/IM/IV or duration >48h; use lower doses in elderly pts; taper total daily dose by no more than 10-25% q2-4wk to D/C if prolonged or long-term use
preoperative sedation
- [50-100 mg SC/IM x1]
- Start: 30-90min before anesthesia; Info: use lower doses in elderly pts
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 pts
renal dosing
- [pain or obstetric analgesia]
- 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 w/ repeat dosing
- HD/PD: avoid use
- [shivering]
- renal impairment: not defined, caution advised
- HD/PD: not defined, caution advised
hepatic dosing
- [see below]
- hepatic impairment: not defined; Info: titrate slowly
Peds Dosing .
- Dosage forms: TAB: 50 mg, 100 mg; INJ (cartridge): 25 mg per mL, 50 mg per mL, 75 mg per mL, 100 mg per mL; INJ (pre-filled syringe): 25 mg per mL, 50 mg per mL, 75 mg per mL, 100 mg per mL; INJ (vial): various
Dosage Form Details
- [SOL form discontinued in US for this brand; see generic]
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: parenteral route preferred to PO route; decr. dose if given IV, dilute prior to use, admin. slowly; use lowest effective dose, shortest effective tx duration; incr. risk of excitatory neurotoxicity, seizure if dose >600 mg/24h SC/IM/IV or duration >48h; taper total daily dose by no more than 10-25% q2-4wk to D/C if prolonged or long-term use
preoperative sedation
- [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 w/ repeat dosing
- HD/PD: avoid use
hepatic dosing
- [see below]
- hepatic impairment: not defined; Info: titrate slowly