Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you.
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases.
If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco. The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:.
A nurse or other trained health professional will give you this medicine in a hospital. This medicine may be given as a shot under the skin, as a shot into one of your muscles, or through a needle placed in one of your veins. It can also be given through a needle or catheter into your back.
Your doctor will give you a few doses of this medicine until your condition improves, and then switch you to an oral medicine that works the same way. If you have any concerns about this, talk to your doctor.
It is very important that your doctor check the progress or you or your child while you are receiving this medicine. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to use it. This medicine will add to the effects of alcohol and other CNS depressants medicines that can make you drowsy or less alert.
Some examples of CNS depressants are antihistamines or medicine for allergies or colds; sedatives, tranquilizers, or sleeping medicine; other prescription pain medicine or narcotics; medicine for seizures or barbiturates; muscle relaxants; or anesthetics, including some dental anesthetics.
Check with your doctor before you or your child take any of the medicines listed above while you are using this medicine. This medicine may be habit-forming. If you or your child feel that the medicine is not working as well, do not use more than your prescribed dose.
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American Psychiatric Association Washington, D. National Institutes of Health. Meperidine: MedlinePlus Drug Information. Showing 4 of 16 Centers. Meperidine may increase the frequency of seizures in patients with a seizure disorder, and may increase the risk of seizures occurring in other clinical settings associated with seizures. Monitor patients with a history of seizure disorder for worsened seizure control during meperidine therapy. Prolonged meperidine use may increase the risk of seizures from the accumulation of the meperidine metabolite, normeperidine.
Opioid agonists, such as meperidine, produce cholinergic side effects by stimulating medullary vagal nuclei causing bradycardia and vasovagal syncope, and induce the release of histamine. In patients who are unable to maintain blood pressure due to hypovolemia or dehydration, or in those who concurrently receive other agents that compromise vasomotor tone e. These effects can cause problems in patients with cardiac disease e.
Meperidine should be used with caution in patients with cardiac arrhythmias or orthostatic hypotension. Patients with atrial flutter or other supraventricular tachycardias may have a significant increase in ventricular response rate due to the vagolytic action of meperidine.
Meperidine should not be used in patients with circulatory shock. Meperidine has been reported to provoke hypertension in patients with pheochromocytoma. Accumulation of meperidine or its active metabolite, normeperidine, may occur in patients with renal impairment or renal failure; therefore, use meperidine with caution in patients with renal disease.
Titrate the dosage slowly in patients with renal impairment, and monitor closely for signs of central nervous system and respiratory depression. Meperidine can cause urinary retention and oliguria, due to increasing the tension of the detrusor muscle. Patients more prone to these effects include those with prostatic hypertrophy, urethral stricture, bladder obstruction, or pelvic tumors.
Use meperidine with caution in patients with hepatic disease. Titrate the meperidine dosage slowly in patients with hepatic impairment, and monitor closely for signs of central nervous system and respiratory depression.
Elevated serum concentrations have also been reported to cause central nervous system excitatory effects. Literature reports indicate that geriatric patients have a slower elimination rate of meperidine compared with younger adult patients.
According to the manufacturer, a reduction in the total daily dose of meperidine is recommended. If meperidine is given, elderly patients should be carefully monitored for adverse effects. According to the Beers Criteria, meperidine is considered a potentially inappropriate medication PIM in geriatric patients; avoid use because safer alternatives are available.
Meperidine may have a higher risk of neurotoxicity including delirium versus other alternatives, and the drug is not an effective oral analgesic in the dosages commonly used. Opiate agonists are considered PIMs in geriatric patients with a history of falls or fractures and should be avoided in these patient populations, except in the setting of severe acute pain, since opiates can produce ataxia, impaired psychomotor function, syncope, and additional falls.
If an opiate must be used, consider reducing use of other CNS-active medications that increase the risk of falls and fractures and implement strategies to reduce fall risk.
In patients receiving palliative care or hospice, the balance of benefits and harms of medication management may differ from those of the general population of older adults.
According to OBRA, meperidine is not an effective oral analgesic in doses commonly used in the elderly, and the drug may cause confusion or respiratory depression, even with therapeutic analgesic doses. The active metabolite of meperidine accumulates with repeated use and has been associated with seizures.
Similar to other opioid agonists, meperidine may also cause CNS and gastrointestinal adverse effects, physical and psychological dependency, and unintended respiratory depression, especially in individuals with compromised pulmonary function.
Some adverse effects can lead to other consequences such as falls. The safety and efficacy of meperidine have not been established in neonates, infants, children, and adolescents. Meperidine has a slower elimination rate in neonates and young infants compared with older children and adults. Neonates and young infants may be more susceptible to adverse effects of meperidine, including respiratory depression.
If meperidine use is considered in the pediatric population, carefully weigh any potential benefit of the drug against risks. Meperidine may impair the physical or mental abilities needed to perform potentially hazardous activities such as driving or operating machinery. Warn patients not to drive or operate dangerous machinery unless they are tolerant to the effects of meperidine and know how they will react to the medication. Abrupt discontinuation of prolonged meperidine therapy can result in withdrawal symptoms.
Gradually taper patients off prolonged meperidine therapy to avoid a withdrawal reaction. Avoid use of partial agonists e. The severity of the withdrawal syndrome produced will depend on the degree of physical dependence and on the administered dose of the concomitant drug. If treatment of respiratory depression in an individual physically dependent on opioids is necessary, administer the opioid antagonist with extreme care; titrate the antagonist dose by using smaller than usual doses.
If necessary, meperidine may be given intravenously, but the injection should be given very slowly, preferably as a diluted solution. When meperidine is given parenterally, especially intravenously, the patient should be lying down. Do not give meperidine by intravenous administration unless an opioid antagonist and the facilities for assisted or controlled respiration are immediately available.
Rapid intravenous injection of meperidine increases the incidence of adverse reactions; severe respiratory depression, apnea, hypotension, peripheral circulatory collapse, and cardiac arrest have occurred. Use meperidine with caution in patients with adrenal insufficiency i.
Such patients may be at increased risk of adverse events. Opioids inhibit the secretion of adrenocorticotropic hormone ACTH , cortisol, and luteinizing hormone LH ; however, the thyroid stimulating hormone may be either stimulated or inhibited by opioids. Rarely, adrenal insufficiency has been reported in association with opioid use. Patients should seek immediate medical attention if they experience symptoms such as nausea, vomiting, loss of appetite, fatigue, weakness, dizziness, or hypotension.
If adrenocortical insufficiency is suspected, confirm with diagnostic testing as soon as possible. If diagnosed, the patient should be treated with physiologic replacement doses of corticosteroids, and if appropriate, weaned off of opioid therapy. If the opioid can be discontinued, a follow-up assessment of adrenal function should be performed to determine if corticosteroid treatment can be discontinued.
Other opioids may be tried; some cases reported use of a different opioid with no recurrence of adrenocortical insufficiency. It is unclear which, if any, opioids are more likely to cause adrenocortical insufficiency. In addition, chronic opioid use may lead to symptoms of hypogonadism, resulting from changes in the hypothalamic-pituitary-gonadal axis. Monitor patients for symptoms of opioid-induced endocrinopathy, particularly those receiving a daily dose equivalent to mg or more of morphine.
Patients presenting with signs or symptoms of androgen deficiency should undergo laboratory evaluation. Meperidine appears in the milk of nursing mothers receiving the drug.
Consider the developmental and health benefits of breast-feeding along with the mother's clinical need for meperidine and any potential adverse effects on the breast-fed infant from meperidine or the underlying maternal condition. Monitor infants exposed to meperidine though breast milk for excess sedation and respiratory depression.
Withdrawal symptoms may occur in breast-fed infants when maternal administration of meperidine is stopped, or when breast-feeding is discontinued. Previous American Academy of Pediatrics AAP recommendations considered the short-term use of meperidine as usually compatible with breast-feeding; however, other expert opinions state the preference for considering alternatives to meperidine, such as morphine.
Analgesics such as acetaminophen and ibuprofen are considered usually compatible with breast-feeding and may represent safer alternatives in some cases. Chronic opioid use may influence the hypothalamic-pituitary-gonadal axis, leading to hormonal changes that may manifest as hypogonadism gonadal suppression and pose a reproductive risk.
Although the exact causal role of opioids in the clinical manifestations of hypogonadism is unknown, patients could experience libido decrease, impotence, amenorrhea, or infertility.
It is not known whether the effects on fertility are reversible. Monitor patients for symptoms of opioid-induced endocrinopathy. Acetaminophen; Chlorpheniramine: Moderate Concomitant use of opioid agonists with chlorpheniramine may cause excessive sedation and somnolence. Limit the use of opioid pain medication with chlorpheniramine to only patients for whom alternative treatment options are inadequate.
If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Acetaminophen; Chlorpheniramine; Dextromethorphan: Moderate Concomitant use of opioid agonists with chlorpheniramine may cause excessive sedation and somnolence.
Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate Concomitant use of opioid agonists with chlorpheniramine may cause excessive sedation and somnolence. Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: Moderate Concomitant use of opioid agonists with chlorpheniramine may cause excessive sedation and somnolence.
Acetaminophen; Chlorpheniramine; Phenylephrine : Moderate Concomitant use of opioid agonists with chlorpheniramine may cause excessive sedation and somnolence. Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine: Moderate Concomitant use of opioid agonists with chlorpheniramine may cause excessive sedation and somnolence.
Acetaminophen; Dextromethorphan; Doxylamine: Moderate Concomitant use of opioid agonists with doxylamine may cause excessive sedation and somnolence.
Limit the use of opioid pain medication with doxylamine to only patients for whom alternative treatment options are inadequate. Acetaminophen; Diphenhydramine: Moderate Concomitant use of opioid agonists with diphenhydramine may cause excessive sedation and somnolence. Limit the use of opioid pain medication with diphenhydramine to only patients for whom alternative treatment options are inadequate. Acetaminophen; Hydrocodone: Major Concomitant use of hydrocodone with other CNS depressants may lead to hypotension, profound sedation, coma, respiratory depression and death.
Prior to concurrent use of hydrocodone in patients taking a CNS depressant, assess the level of tolerance to CNS depression that has developed, the duration of use, and the patient's overall response to treatment. Consider the patient's use of alcohol or illicit drugs. Also consider a using a lower dose of the CNS depressant. Monitor patients for sedation and respiratory depression.
Hypotension, profound sedation, coma, respiratory depression, or death may occur. Prior to concurrent use of oxycodone in patients taking a CNS depressant, assess the level of tolerance to CNS depression that has developed, the duration of use, and the patient's overall response to treatment.
Monitor for sedation and respiratory depression. Acetaminophen; Pamabrom; Pyrilamine: Moderate Concomitant use of opioid agonists with pyrilamine may cause excessive sedation and somnolence. Limit the use of opioid pain medication with pyrilamine to only patients for whom alternative treatment options are inadequate. Acetaminophen; Pentazocine: Major Avoid the concomitant use of pentazocine and opiate agonists, such as meperidine.
Pentazocine may cause withdrawal symptoms in patients receiving chronic opiate agonists. Concurrent use of pentazocine with other opiate agonists can cause additive CNS, respiratory, and hypotensive effects. The additive or antagonistic effects are dependent upon the dose of the opiate agonist used; antagonistic effects are more common at low to moderate doses of the opiate agonist. Acrivastine; Pseudoephedrine: Major Avoid coadministration of opioid agonists with acrivastine due to the risk of additive CNS depression.
Therefore, psychotropic pharmacodynamic interactions could occur following concomitant administration of drugs with significant CNS or psychotropic activity such as opiate agonists. In addition, aldesleukin, IL-2, is a CYP3A4 inhibitor and may increase oxycodone plasma concentrations and related toxicities including potentially fatal respiratory depression.
If therapy with both agents is necessary, monitor patients for an extended period and adjust oxycodone dosage as necessary. Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ: Moderate Monitor for decreased diuretic efficacy and additive orthostatic hypotension when thiazide diuretics are administered with meperidine. Adjustments to diuretic therapy may be needed in some patients. The efficacy of diuretics may be reduced due to opioid-induced release of antidiuretic hormone. Aliskiren; Hydrochlorothiazide, HCTZ: Moderate Monitor for decreased diuretic efficacy and additive orthostatic hypotension when thiazide diuretics are administered with meperidine.
Alosetron: Major Patients taking medications that decrease GI motility may be at greater risk for serious complications from alosetron, like constipation, via a pharmacodynamic interaction. Constipation is the most frequently reported adverse effect with alosetron. Alprazolam: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death.
Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. If an opiate agonist is initiated in a patient taking a benzodiazepine, use a lower initial dose of the opiate and titrate to clinical response.
If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. Educate patients about the risks and symptoms of respiratory depression and sedation.
Alvimopan: Moderate Patients should not take alvimopan if they have received therapeutic doses of opiate agonists for more than seven consecutive days immediately before initiation of alvimopan therapy.
Patients recently exposed to opioids are expected to be more sensitive to the effects of mu-opioid receptor antagonists and may experience adverse effects localized to the gastrointestinal tract such as abdominal pain, nausea, vomiting, and diarrhea.
Amide local anesthetics: Moderate The use of these drugs together must be approached with caution. Although commonly used together for additive analgesic effects, the patient must be monitored for respiratory depression, hypotension, and excessive sedation due to additive effects on the CNS and blood pressure. In rare instances, serious morbidity and mortality has occurred.
Limit the use of opiate pain medications with local anesthetics to only patients for whom alternative treatment options are inadequate. The use of the local anesthetic will allow for the use a lower initial dose of the opiate and then the doses can be titrated to proper clinical response. Amiloride: Moderate Monitor for decreased diuretic efficacy and additive orthostatic hypotension when amiloride is administered with meperidine.
Amiloride; Hydrochlorothiazide, HCTZ: Moderate Monitor for decreased diuretic efficacy and additive orthostatic hypotension when amiloride is administered with meperidine. Moderate Monitor for decreased diuretic efficacy and additive orthostatic hypotension when thiazide diuretics are administered with meperidine.
Amitriptyline: Major Concomitant use of meperidine with tricyclic antidepressants TCAs may cause excessive sedation and somnolence. Limit the use of opioid pain medications with TCAs to only patients for whom alternative treatment options are inadequate.
If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Also monitor patients for the emergence of serotonin syndrome or signs of urinary retention or reduced gastric motility. Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. The concomitant use of opioids with other drugs that affect the serotonergic neurotransmitter system has resulted in serotonin syndrome.
Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: Moderate Monitor for decreased diuretic efficacy and additive orthostatic hypotension when thiazide diuretics are administered with meperidine.
Amobarbital: Major Concomitant use of meperidine with a barbiturate may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opioid pain medications with a barbiturate to only patients for whom alternative treatment options are inadequate. Additionally, concurrent use of meperidine with a barbiturate may decrease meperidine plasma concentrations, decrease opioid efficacy, and potentially lead to a withdrawal syndrome in those with physical dependence to opioid agonists.
Monitor for signs of opioid withdrawal. Discontinuation of a barbiturate may increase the risk of increased opioid-related adverse reactions, such as fatal respiratory depression. Amoxapine: Moderate Concomitant use of mepridine with amoxapine may cause additive sedation and somnolence. Limit the use of opioid pain medications to patients for whom alternative treatment options are inadequate. Educate patients about the risks and symptoms of excessive CNS depression. Monitor for other additive effects, such as constipation or urinary retention.
Amphetamine: Moderate If concomitant use of meperidine and amphetamines is warranted, monitor patients for the emergence of serotonin syndrome.
Amphetamine; Dextroamphetamine: Moderate If concomitant use of meperidine and amphetamines is warranted, monitor patients for the emergence of serotonin syndrome. Amphetamines: Moderate If concomitant use of meperidine and amphetamines is warranted, monitor patients for the emergence of serotonin syndrome. Anticholinergics: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when meperidine is used concomitantly with an anticholinergic drug.
Opiates increase the tone and decrease the propulsive contractions of the smooth muscle of the gastrointestinal tract. Prolongation of the gastrointestinal transit time may be the mechanism of the constipating effect. Apomorphine: Major Concomitant use of opioid agonists with apomorphine may cause excessive sedation and somnolence.
Limit the use of opioid pain medications with apomorphine to only patients for whom alternative treatment options are inadequate. Dopaminergic agents like apomorphine have also been associated with sudden sleep onset during activities of daily living such as driving, which has resulted in accidents in some cases.
Prescribers should re-assess patients for drowsiness or sleepiness regularly throughout treatment, especially since events may occur well after the start of treatment. Apraclonidine: Minor Theoretically, apraclonidine might potentiate the effects of CNS depressant drugs such as opiate agonists. Although no specific drug interactions were identified with systemic agents and apraclonidine during clinical trials, apraclonidine can cause dizziness and somnolence. Aripiprazole: Moderate Concomitant use of opioid agonists with aripiprazole may cause excessive sedation and somnolence.
Limit the use of opioid pain medications with aripiprazole to only patients for whom alternative treatment options are inadequate. Articaine; Epinephrine: Moderate The use of these drugs together must be approached with caution.
Asciminib: Moderate Consider a reduced dose of meperidine with frequent monitoring for respiratory depression and sedation if concurrent use of asciminib is necessary. If asciminib is discontinued, meperidine plasma concentrations can decrease resulting in reduced efficacy and potential withdrawal syndrome in a patient who has developed physical dependence to meperidine. Concomitant use with asciminib can increase meperidine exposure resulting in increased or prolonged opioid effects including fatal respiratory depression, particularly when an inhibitor is added to a stable dose of meperidine.
Asenapine: Moderate Concomitant use of opioid agonists with asenapine may cause excessive sedation and somnolence. Limit the use of opioid pain medications with asenapine to only patients for whom alternative treatment options are inadequate. Aspirin, ASA; Butalbital; Caffeine: Major Concomitant use of meperidine with a barbiturate may cause respiratory depression, hypotension, profound sedation, and death. Aspirin, ASA; Butalbital; Caffeine; Codeine: Major Concomitant use of meperidine with a barbiturate may cause respiratory depression, hypotension, profound sedation, and death.
Aspirin, ASA; Caffeine; Orphenadrine: Major Concomitant use of opioid agonists with orphenadrine may cause excessive sedation and somnolence. Limit the use of opioid pain medications with orphenadrine to only patients for whom alternative treatment options are inadequate. Aspirin, ASA; Carisoprodol: Major Concomitant use of opioid agonists with carisoprodol may cause excessive sedation and somnolence.
Limit the use of opioid pain medications with carisoprodol to only patients for whom alternative treatment options are inadequate. Aspirin, ASA; Carisoprodol; Codeine: Major Concomitant use of opioid agonists with carisoprodol may cause excessive sedation and somnolence. Atenolol; Chlorthalidone: Moderate Monitor for decreased diuretic efficacy and additive orthostatic hypotension when thiazide diuretics are administered with meperidine.
Atropine: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when meperidine is used concomitantly with an anticholinergic drug. Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: Contraindicated Meperidine use in patients taking methylene blue or within 14 days of stopping such treatment is contraindicated due to the risk of serotonin syndrome or precipitation of other unpredictable, severe, and occasionally fatal reactions, possibly related to preexisting hyperphenylalaninemia.
Moderate Monitor patients for signs of urinary retention or reduced gastric motility when meperidine is used concomitantly with an anticholinergic drug. Use caution during coadministration.
Reduced GI motility when combined with opiate agonists may increase the risk of serious GI related adverse events. Atropine; Edrophonium: Moderate Monitor patients for signs of urinary retention or reduced gastric motility when meperidine is used concomitantly with an anticholinergic drug.
Avacopan: Moderate Consider a reduced dose of meperidine with frequent monitoring for respiratory depression and sedation if concurrent use of avacopan is necessary. If avacopan is discontinued, meperidine plasma concentrations can decrease resulting in reduced efficacy and potential withdrawal syndrome in a patient who has developed physical dependence to meperidine. Concomitant use with avacopan can increase meperidine exposure resulting in increased or prolonged opioid effects including fatal respiratory depression, particularly when an inhibitor is added to a stable dose of meperidine.
Azelastine: Major Concomitant use of opioid agonists with azelastine may cause excessive sedation and somnolence. Limit the use of opioid pain medications with azelastine to only patients for whom alternative treatment options are inadequate.
Azelastine; Fluticasone: Major Concomitant use of opioid agonists with azelastine may cause excessive sedation and somnolence. Azilsartan; Chlorthalidone: Moderate Monitor for decreased diuretic efficacy and additive orthostatic hypotension when thiazide diuretics are administered with meperidine. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information.
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Meperidine Hydrochloride slide 8 of 10, Meperidine Hydrochloride,. Meperidine Hydrochloride slide 9 of 10, Meperidine Hydrochloride,. Meperidine Hydrochloride slide 10 of 10, Meperidine Hydrochloride,. What is the most important information I should know about meperidine? What is meperidine? Meperidine is an opioid medication used to treat moderate-to-severe pain. Meperidine may also be used for purposes not listed in this medication guide. What should I discuss with my healthcare provider before using meperidine?
You should not use meperidine if you are allergic to it, or if you have:. How should I use meperidine? What happens if I miss a dose? What happens if I overdose? What should I avoid while using meperidine?
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