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 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
extended use in pregnant pts can lead to potentially life-threatening neonatal opioid withdrawal syndrome; advise pregnant pts of risks and ensure tx by neonatology experts avail. at delivery if extended opioid use required
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; SOL: 10 mg per mL; INJ: various
Special Note
- [prescribing info]
- Info: consider prescribing naloxone if risk of opioid overdose or accidental ingestion
pain, mod-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; SOL: 10 mg per mL; INJ: various
Special Note
- [prescribing info]
- Info: consider prescribing naloxone if risk of opioid overdose or accidental ingestion
pain, mod-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