Uses
Acute Pain
A strong analgesic used in the relief of moderate to severe pain.
Usually, temporary relief of moderate to severe pain such as that associated with acute and some chronic medical disorders including renal or biliary colic, acute trauma, postoperative pain, and cancer.
Used to provide analgesia during diagnostic and orthopedic procedures and during labor.
For preoperative sedation and as a supplement to anesthesia.
Around-the-clock dosing of analgesics may be considered in the initial stages of acute pain to avoid wide swings in pain and sedation often associated with as-needed dosing regimens.
Although commonly used for acute pain relief, use as first-line opiate therapy is discouraged because of central excitatory toxicity of metabolite (normeperidine).
Because of extensive first-pass metabolism in the liver to normeperidine, the risk of excitatory toxicity is increased with oral administration of meperidine; therefore, oral therapy is discouraged.
Has been used to relieve the pain of MI, although probably not as effective as morphine sulfate.
Chronic Pain
Use for chronic pain is discouraged because of short duration of effect and risk of accumulation of normeperidine metabolite and resultant central excitatory toxicity with repeated or large doses.
Surgery
Used parenterally for preoperative sedation and as a supplement to anesthesia.
Pulmonary Edema
Used in patients with acute pulmonary edema† for its cardiovascular effects and to allay anxiety.
Do not use in the treatment of pulmonary edema resulting from a chemical respiratory irritant.
Dosage and Administration
General
- Give the smallest effective dose and as infrequently as possible to minimize the development of tolerance and physical dependence.
- Reduced dosage is indicated initially in poor-risk patients, in geriatric and very young patients, in patients with renal (particularly) or hepatic impairment, and in patients receiving other CNS depressants.
- Reduce meperidine dose by 25–50% when used in conjunction with other CNS depressants (e.g., phenothiazines, other tranquilizers); dosage adjustment for the concomitantly administered drug also may be necessary.
- Orally, 300 mg is approximately equianalgesic with 30 mg morphine sulfate. Parenterally, 75–100 mg is approximately equianalgesic with 10 mg morphine sulfate. (For specific patient dosages, see dosage recommendations in Dosage and also see Prescribing Limits under Dosage and Administration.)
- Generally limit to short-term use (a few days) because of risk of accumulation of toxic normeperidine metabolite with repeated or large doses.
Administration
Administer orally; by sub-Q, IM, or slow IV injection; or by slow, continuous IV infusion.
Oral Administration
Least effective when given orally. Higher dosages may be necessary for pain relief, but the risk of toxicity from metabolite normeperidine is increased.
Oral therapy is discouraged because of extensive first-pass metabolism in the liver and resultant increased formation of the toxic metabolite (normeperidine).
Dilution
Dilute each dose of oral solution in ½ glassful of water, since undiluted solution may produce slight topical anesthesia on mucous membranes.
IV Administration
Administer by direct IV injection, IV infusion, or IV via a controlled-delivery device for patient-controlled analgesia (PCA).
If IV administration is required, decrease dosage and administer injections very slowly, preferably as a 10-mg/mL injection.
Alternatively, may use the commercially available injection containing 10 mg/mL intended for use with a compatible infusion device (does not require further dilution); this 10-mg/mL injection is for single use only, and unused portions should be discarded appropriately.
When given parenterally, especially by the IV route, the patient should be lying down.
During and immediately following IV administration, an opiate antagonist and facilities for administration of oxygen and control of respiration should be available.
Dilution
May dilute in a compatible IV solution for infusion, usually to a concentration of 1 mg/mL. (See Solution Compatibility under Compatibility.)
Rate of Administration
Direct IV injection: Usually, very slowly, preferably as a 10-mg/mL injection.
IV injection for PCA: Self-administered intermittently as needed (“prn”) via controlled-delivery device, with usual lockout intervals (minimum time between self-administered doses programmed into device) of 6–12 minutes.
IV infusion, adults: Usually, 15–35 mg/hour.
IM Administration
Inject into a large muscle mass, taking care to avoid nerve trunks.
IM injection is discouraged for any analgesic (e.g., the injection itself is painful, delayed onset).
When repeat parenteral doses are necessary and IV therapy is not used, IM is preferred over sub-Q administration because of occurrence of local tissue irritation and induration following sub-Q injection.
Epidural Administration
Preservative-free injections have been injected or infused epidurally†; specialized techniques are required for administration of the drug by this route, and such administration should be performed only by qualified individuals familiar with the techniques of administration, dosages, and special patient management problems associated with epidural meperidine hydrochloride administration.
Dosage
Pediatric Patients
Some experts discourage use in children.
Usual Dosage
Oral, IM, or Sub-Q
May receive 1.1–1.8 mg/kg (up to adult dose) orally, IM, or sub-Q every 3–4 hours as needed.
Alternatively, 175 mg/m2 daily in 6 divided doses orally, IM, or sub-Q.
Single pediatric doses should not exceed 100 mg.
IV
Do not use for PCA when analgesic consumption is expected to be high; risk of CNS excitatory toxicity from normeperidine.
PCA (usually IV) via controlled-delivery device: Loading doses of 0.5–1.5 mg/kg, preferably titrated by clinician or nurse at bedside.
PCA (usually IV) via controlled-delivery device: Maintenance doses (administered intermittently) of 0.1–0.2 mg/kg, self-administered usually no more frequently than every 6–12 minutes as a device-programmed lockout period.
Preoperative Dosage
IM or Sub-Q
May receive 1–2.2 mg/kg (maximum up to the adult dose) IM or sub-Q 30–90 minutes before the beginning of anesthesia.
Adjunct to Anesthesia
IV Injection or IV Infusion
May be given by repeated slow IV injections of a dilute solution (e.g., containing 10 mg/mL) or by continuous IV infusion of a more dilute solution (e.g., containing 1 mg/mL).
Adults
Usual Dosage
Oral, IM, or Sub-Q
Usually, 50–150 mg every 3–4 hours as needed.
IV infusion
Usually, 15–35 mg/hour.
IV
Do not use for PCA when analgesic consumption is expected to be high; risk of CNS excitatory toxicity from normeperidine.
PCA (usually IV) via controlled-delivery device: Loading doses of 12.5–25 mg every 10 minutes, preferably titrated by clinician or nurse at bedside, up to 50–125 mg total.
PCA (usually IV) via controlled-delivery device: Maintenance doses (self-administered intermittently) of 5–10 mg, self-administered usually no more frequently than every 6–12 minutes as a device-programmed lockout period.
Preoperative Dosage
IM or Sub-Q
Usually, 50–100 mg IM or sub-Q 30–90 minutes before the beginning of anesthesia.
Adjunct to Anesthesia
IV Injection or IV Infusion
May be given by repeated slow IV injections of a dilute solution (e.g., containing 10 mg/mL) or by continuous IV infusion of a more dilute solution (e.g., containing 1 mg/mL).
Analgesia during Labor
IM or Sub-Q
50–100 mg when labor pains become regular; repeat at 1- to 3-hour intervals as needed.
Prescribing Limits
Pediatric Patients
Oral, IM, or Sub-Q
Single pediatric doses should not exceed 100 mg.
Adults
Oral, IV, IM, or Sub-Q
Increased risk of toxicity from the active metabolite, normeperidine, when given for >48 hours or in total dosages exceeding 600 mg/24 hours. (See Elimination under Pharmacokinetics.)
Special Populations
Dosage in Hepatic Impairment
Adjustment in the dose, frequency, and/or duration of therapy may be necessary because accumulation of the drug and/or its toxic metabolite, normeperidine, can occur.
Certain adverse effects secondary to CNS stimulation (e.g., seizures, agitation, irritability, nervousness, tremors, twitches, myoclonus) have been attributed to accumulation of normeperidine.
Oral bioavailability may be increased substantially in these patients. (See Pharmacokinetics.)
Dosage in Renal Impairment
Generally avoid in renal impairment, particularly repeated or high doses.
If used, adjustment in the dose, frequency, and/or duration of meperidine therapy is likely to be necessary because accumulation of the drug and/or its toxic metabolite, normeperidine, can occur.
Certain adverse effects secondary to CNS stimulation (e.g., seizures, agitation, irritability, nervousness, tremors, twitches, myoclonus) have been attributed to accumulation of normeperidine.
End-stage Renal Failure
Avoid because of the risk of accumulation of the toxic metabolite, normeperidine.
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