meperidine hydrochloride (pethidine)

Drug Name

Generic Name :  meperidine hydrochloride (pethidine)

Brand Name: Demerol

Classification: Opioid agonist analgesic

Pregnancy Category B
Pregnancy Category D (prolonged use)
Controlled Substance C-II 

Dosage & Route

Available forms : Tablets—50, 100 mg; syrup—50 mg/5 mL; injection—25, 50, 75, 100 mg/mL

ADULTS
  • Relief of pain: Individualize dosage; 50–150 mg IM, subcutaneously, or PO q 3–4 hr as needed. Diluted solution may be given by slow IV injection. IM route is preferred for repeated injections.
  • Preoperative medication: 50–100 mg IM or subcutaneously, 30–90 min before beginning anesthesia.
  • Support of anesthesia: Dilute to 10 mg/mL, and give repeated doses by slow IV injection, or dilute to 1 mg/mL and infuse continuously. Individualize dosage.
  • Obstetric analgesia: When contractions become regular, 50–100 mg IM or subcutaneously; repeat q 1–3 hr.
PEDIATRIC PATIENTS
  • Contraindicated in premature infants.
    • Relief of pain: 1.1–1.75 mg/kg IM, subcutaneously, or PO up to adult dose q 3–4 hr as needed.
    • Preoperative medication: 1.1–2.2 mg/kg IM or subcutaneously, up to adult dose, 30–90 min before beginning anesthesia.
GERIATRIC PATIENTS OR IMPAIRED ADULTS
  • Use caution; respiratory depression may occur in elderly, the very ill, those with respiratory problems. Reduced dosage may be needed.
Therapeutic actions
  • Acts as agonist at specific opioid receptors in the CNS to produce analgesia, euphoria, sedation; the receptors mediating these effects are thought to be the same as those mediating the effects of endogenous opioids (enkephalins, endorphins).
Indications
  • Oral, parenteral: Relief of moderate to severe acute pain
  • Parenteral: Preoperative medication, support of anesthesia, and obstetric analgesia
Adverse effects
  • CNS: Light-headedness, dizziness, sedation, euphoria, dysphoria, delirium, insomnia, agitation, anxiety, fear, hallucinations, disorientation, drowsiness, lethargy, impaired mental and physical performance, coma, mood changes, weakness, headache, tremor, seizures, miosis, visual disturbances, suppression of cough reflex
  • CV: Facial flushing, peripheral circulatory collapse, tachycardia, bradycardia, arrhythmia, palpitations, chest wall rigidity, hypertension, hypotension, orthostatic hypotension, syncope
  • Dermatologic: Pruritus, urticaria, laryngospasm, bronchospasm, edema
  • GI: Nausea, vomiting, dry mouth, anorexia, constipation, biliary tract spasm, increased colonic motility in patients with chronic ulcerative colitis
  • GU: Ureteral spasm, spasm of vesical sphincters, urine retention or hesitancy, oliguria, antidiuretic effect, reduced libido or potency
  • Local: Tissue irritation and induration (subcutaneous injection)
  • Major hazards: Respiratory depression, apnea, circulatory depression, respiratory arrest, shock, cardiac arrest
  • Other: Sweating, physical tolerance and dependence, psychological dependence
Contraindications
  • Contraindicated with hypersensitivity to opioids, diarrhea caused by poisoning (before toxins are eliminated), bronchial asthma, COPD, cor pulmonale, respiratory depression, anoxia, kyphoscoliosis, acute alcoholism, increased intracranial pressure, pregnancy, seizure disorder, renal impairment. Contraindicated in premature infants.
  •  Use cautiously with acute abdominal conditions, CV disease, supraventricular tachycardias, myxedema, delirium tremens, cerebral arteriosclerosis, ulcerative colitis, fever, Addison’s disease, prostatic hypertrophy, urethral stricture, recent GI or GU surgery, toxic psychosis, labor or delivery (opioids given to the mother can cause respiratory depression of neonate; premature infants are especially at risk), renal or hepatic impairment, lactation.
Nursing considerations
Assessment
  • History: Hypersensitivity to opioids, diarrhea caused by poisoning, bronchial asthma, COPD, cor pulmonale, respiratory depression, anoxia, kyphoscoliosis, acute alcoholism, increased intracranial pressure; acute abdominal conditions, CV disease, supraventricular tachycardias, myxedema, seizure disorders, delirium tremens, cerebral arteriosclerosis, ulcerative colitis, fever, Addison’s disease, prostatic hypertrophy, urethral stricture, recent GI or GU surgery, toxic psychosis, renal or hepatic impairment, pregnancy, lactation
  • Physical: T; skin color, texture, lesions; orientation, reflexes, bilateral grip strength, affect, pupil size; P, auscultation, BP, orthostatic BP, perfusion; R, adventitious sounds; bowel sounds, normal output; frequency and pattern of voiding, normal output; ECG; EEG; LFTs, renal and thyroid function tests
Interventions
  • Administer to lactating women 4–6 hr before the next feeding to minimize the amount in milk.
  • WARNING: Keep opioid antagonist and facilities for assisted or controlled respiration readily available during parenteral administration.
  • WARNING: Use caution when injecting subcutaneously into chilled areas of the body or in patients with hypotension or in shock; impaired perfusion may delay absorption; with repeated doses, an excessive amount may be absorbed when circulation is restored.
  • Reduce dosage of meperidine by 25%–50% in patients receiving phenothiazines or other tranquilizers.
  • Give each dose of the oral syrup in half glass of water. If taken undiluted, it may exert a slight local anesthetic effect on mucous membranes.
  • Reassure patient that addiction is unlikely; most patients who receive opiates for medical reasons do not develop dependence syndromes.
  • WARNING: Use meperidine with extreme caution in patients with renal impairment or those requiring repeated dosing due to accumulation of normeperidine, a toxic metabolite that may cause seizures.
Teaching points
  • Take drug exactly as prescribed.
  • Avoid alcohol, antihistamines, sedatives, tranquilizers, over-the-counter drugs.
  • Do not take leftover medication for other disorders, and do not let anyone else take this prescription.
  •  You may experience these side effects: Nausea, loss of appetite (take with food and lie quietly, eat frequent small meals); constipation (request a laxative); dizziness, sedation, drowsiness, impaired visual acuity (avoid driving, performing other tasks that require alertness, visual acuity).
  • Report severe nausea, vomiting, constipation, shortness of breath, or difficulty breathing.