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Meperidine Hydrochloride
Overview
What is Meperidine Hydrochloride?
Meperidine Hydrochloride Injection, USP is a sterile solution for
intramuscular, subcutaneous or slow intravenous use as a narcotic analgesic.
Each mL of the DOSETTE vial contains meperidine hydrochloride, either 25 mg,
50 mg, 75 mg or 100 mg in Water for Injection. Buffered with acetic acid-sodium
acetate. pH 3.5-6.0.
Meperidine hydrochloride is ethyl 1-methyl-4-phenylisonipecotate
hydrochloride, a white crystalline substance with a melting point of 186°-189°C.
It is readily soluble in water and has a slightly bitter taste. Its structural
formula is as follows:
What does Meperidine Hydrochloride look like?
What are the available doses of Meperidine Hydrochloride?
Sorry No records found.
What should I talk to my health care provider before I take Meperidine Hydrochloride?
Sorry No records found
How should I use Meperidine Hydrochloride?
For the relief of moderate to severe pain.
For preoperative medication.
For support of anesthesia.
For obstetrical analgesia.
Dosage should be adjusted according to the severity of the pain
and the response of the patient. While subcutaneous administration is suitable
for occasional use, intramuscular administration is preferred when repeated
doses are required. If intravenous administration is required, dosage should be
decreased and the injection made very slowly, preferably utilizing a diluted
solution. Meperidine is less effective orally than by parenteral administration.
The dose of meperidine should be proportionately reduced (usually by 25 to 50
percent) when administered concomitantly with phenothiazines and many other
tranquilizers since they potentiate the action of meperidine.
The usual dosage is 50 to 150 mg intramuscularly or
subcutaneously every 3 to 4 hours as necessary. Elderly patients should usually
be given meperidine at the lower end of the dose range and observed
closely.
The usual dosage is 0.5 to 0.8 mg/lb intramuscularly or
subcutaneously up to the adult dose, every 3 to 4 hours as necessary.
The usual dosage is 50 to 150 mg intramuscularly or
subcutaneously every 3 to 4 hours as necessary. Elderly patients should usually
be given meperidine at the lower end of the dose range and observed
closely.
The usual dosage is 0.5 to 1 mg/lb intramuscularly or
subcutaneously up to the adult dose, 30 to 90 minutes before the beginning of
anesthesia.
Repeated slow intravenous injections of fractional doses (e.g.,
10 mg/mL) or by a continuous intravenous infusion of a more dilute solution
(e.g., 1 mg/mL) should be used. The dose should be titrated to the needs of the
patient and will depend on the premedication and type of anesthesia being
employed, the characteristics of the particular patient and the nature and
duration of the operative procedure. Elderly patients should usually be given
meperidine at the lower end of the dose range and observed closely.
The usual dosage is 50 to 100 mg intramuscularly or
subcutaneously when pain becomes regular and may be repeated at 1 to 3 hour
intervals.
Parenteral drug products should be inspected visually for
particulate matter and discoloration prior to administration, whenever solution
and container permit.
What interacts with Meperidine Hydrochloride?
Hypersensitivity to meperidine.
Meperidine is contraindicated in patients who are receiving monoamine oxidase (MAO) inhibitors or those who have recently received such agents. Therapeutic doses of meperidine have occasionally precipitated unpredictable, severe and occasionally fatal reactions in patients who have received such agents within 14 days. The mechanism of these reactions is unclear, but may be related to a preexisting hyperphenylalaninemia. Some have been characterized by coma, severe respiratory depression, cyanosis and hypotension and have resembled the syndrome of acute narcotic overdose. In other reactions, the predominant manifestations have been hyperexcitability, convulsions, tachycardia, hyperpyrexia and hypertension. Although it is not known that other narcotics are free of the risk of such reactions, virtually all of the reported reactions have occurred with meperidine. If a narcotic is needed in such patients, a sensitivity test should be performed in which repeated, small, incremental doses of morphine are administered over the course of several hours while the patient’s condition and vital signs are under careful observation. (Intravenous hydrocortisone or prednisolone have been used to treat severe reactions, with the addition of intravenous chlorpromazine in those cases exhibiting hypertension and hyperpyrexia. The usefulness and safety of narcotic antagonists in the treatment of these reactions is unknown.)
Solutions of meperidine hydrochloride and barbiturates are chemically incompatible.
What are the warnings of Meperidine Hydrochloride?
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Meperidine can produce drug dependence of the morphine type and
therefore has the potential for being abused. Psychic dependence, physical
dependence and tolerance may develop upon repeated administration of meperidine.
It should be prescribed and administered with the same degree of caution
appropriate to the use of morphine. Like other narcotics, meperidine is subject
to the provisions of the Federal narcotic laws.
MEPERIDINE SHOULD BE USED WITH GREAT CAUTION AND IN REDUCED
DOSAGE IN PATIENTS WHO ARE CONCURRENTLY RECEIVING OTHER NARCOTIC ANALGESICS,
GENERAL ANESTHETICS, PHENOTHIAZINES, OTHER TRANQUILIZERS (SEE ), SEDATIVEHYPNOTICS (INCLUDING
BARBITURATES), TRICYCLIC ANTIDEPRESSANTS AND OTHER CNS DEPRESSANTS (INCLUDING
ALCOHOL). RESPIRATORY DEPRESSION, HYPOTENSION AND PROFOUND SEDATION OR COMA MAY
RESULT.
The respiratory depressant effects of meperidine and its capacity
to elevate cerebrospinal fluid pressure may be markedly exaggerated in the
presence of head injury, other intracranial lesions or a preexisting increase in
intracranial pressure. Furthermore, narcotics produce adverse reactions which
may obscure the clinical course of patients with head injuries. In such
patients, meperidine must be used with extreme caution and only if its use is
deemed essential.
If necessary, meperidine may be given intravenously, but the
injection should be given very slowly, preferably in the form of a diluted
solution. Rapid intravenous injection of narcotic analgesics, including
meperidine, increases the incidence of adverse reactions; severe respiratory
depression, apnea, hypotension, peripheral circulatory collapse and cardiac
arrest have occurred. Meperidine should not be administered intravenously unless
a narcotic antagonist and the facilities for assisted or controlled respiration
are immediately available. When meperidine is given parenterally, especially
intravenously, the patient should be lying down.
Meperidine should be used with extreme caution in patients having
an acute asthmatic attack, patients with chronic obstructive pulmonary disease
or cor pulmonale, patients having a substantially decreased respiratory reserve
and patients with preexisting respiratory depression, hypoxia or hypercapnia. In
such patients, even usual therapeutic doses of narcotics may decrease
respiratory drive while simultaneously increasing airway resistance to the point
of apnea.
The administration of meperidine may result in severe hypotension
in the postoperative patient or any individual whose ability to maintain blood
pressure has already been compromised by a depleted blood volume or
administration of drugs, such as the phenothiazines or certain
anesthetics.
Meperidine may impair the mental and/or physical abilities
required for the performance of potentially hazardous tasks such as driving a
car or operating machinery. The patient should be cautioned accordingly.
Meperidine, like other narcotics, may produce orthostatic hypotension in
ambulatory patients.
Meperidine should not be used in pregnant women prior to the
labor period, unless in the judgment of the physician the potential benefits
outweigh the possible hazards, because safe use in pregnancy prior to labor has
not been established relative to possible adverse effects on fetal
development.
When used as an obstetrical analgesic, meperidine crosses the placental
barrier and can produce depression of respiration and psychophysiologic
functions in the newborn. Resuscitation may be required (see section on ).
Meperidine appears in the milk of nursing mothers receiving the drug.
What are the precautions of Meperidine Hydrochloride?
As with all intramuscular preparations, meperidine intramuscular
injection should be injected well within the body of a large muscle.
Meperidine should be used with caution in patients with atrial
flutter and other supraventricular tachycardias because of a possible vagolytic
action which may produce a significant increase in the ventricular response
rate.
Meperidine may aggravate preexisting convulsions in patients with
convulsive disorders. If dosage is escalated substantially above recommended
levels because of tolerance development, convulsions may occur in individuals
without a history of convulsive disorders.
The administration of meperidine or other narcotics may obscure
the diagnosis or clinical course in patients with acute abdominal
conditions.
Meperidine should be given with caution and the initial dose
should be reduced in certain patients such as the elderly or debilitated and
those with severe impairment of hepatic or renal function, hypothyroidism,
Addison’s disease and prostatic hypertrophy or urethral stricture.
Clinical studies of meperidine did not include sufficient numbers
of subjects aged 65 and over to determine whether they respond differently from
younger subjects. Other reported clinical experience has not identified
differences in response between the elderly and younger patients. In general,
dose selection for an elderly patient should be low, usually starting at the low
end of the dosing range, reflecting the greater frequency of decreased hepatic,
renal, or cardiac function, and of concomitant disease or other drug therapy.
Doses of meperidine should be reduced in elderly patients. (See .)
Sedating drugs may cause confusion and oversedation in the elderly; elderly
patients generally should be started on low doses of meperidine and observed
closely.
This drug is known to be substantially excreted by the kidney, and the risk
of toxic reactions to this drug may be greater in patients with impaired renal
function. Because elderly patients are more likely to have decreased renal
function, care should be taken in dose selection, and it may be useful to
monitor renal function.
Clinical studies indicate that differences in various pharmacokinetic
parameters may exist between elderly and younger patients. (See .)
What are the side effects of Meperidine Hydrochloride?
The major hazards of meperidine, as with other narcotic
analgesics, are respiratory depression and, to a lesser degree, circulatory
depression; respiratory arrest, shock and cardiac arrest have occurred.
The most frequently observed adverse reactions include lightheadedness,
dizziness, sedation, nausea, vomiting and sweating. These effects seem to be
more prominent in ambulatory patients and in those who are not experiencing
severe pain. In such individuals, lower doses are advisable. Some adverse
reactions in ambulatory patients may be alleviated if the patient lies down.
Other adverse reactions include:
Central Nervous System
Gastrointestinal
Cardiovascular
Genitourinary
Allergic
Other
What should I look out for while using Meperidine Hydrochloride?
Hypersensitivity to meperidine.
Meperidine is contraindicated in patients who are receiving monoamine oxidase
(MAO) inhibitors or those who have recently received such agents. Therapeutic
doses of meperidine have occasionally precipitated unpredictable, severe and
occasionally fatal reactions in patients who have received such agents within 14
days. The mechanism of these reactions is unclear, but may be related to a
preexisting hyperphenylalaninemia. Some have been characterized by coma, severe
respiratory depression, cyanosis and hypotension and have resembled the syndrome
of acute narcotic overdose. In other reactions, the predominant manifestations
have been hyperexcitability, convulsions, tachycardia, hyperpyrexia and
hypertension. Although it is not known that other narcotics are free of the risk
of such reactions, virtually all of the reported reactions have occurred with
meperidine. If a narcotic is needed in such patients, a sensitivity test should
be performed in which repeated, small, incremental doses of morphine are
administered over the course of several hours while the patient’s condition and
vital signs are under careful observation. (Intravenous hydrocortisone or
prednisolone have been used to treat severe reactions, with the addition of
intravenous chlorpromazine in those cases exhibiting hypertension and
hyperpyrexia. The usefulness and safety of narcotic antagonists in the treatment
of these reactions is unknown.)
Solutions of meperidine hydrochloride and barbiturates are chemically
incompatible.
Meperidine can produce drug dependence of the morphine type and
therefore has the potential for being abused. Psychic dependence, physical
dependence and tolerance may develop upon repeated administration of meperidine.
It should be prescribed and administered with the same degree of caution
appropriate to the use of morphine. Like other narcotics, meperidine is subject
to the provisions of the Federal narcotic laws.
MEPERIDINE SHOULD BE USED WITH GREAT CAUTION AND IN REDUCED
DOSAGE IN PATIENTS WHO ARE CONCURRENTLY RECEIVING OTHER NARCOTIC ANALGESICS,
GENERAL ANESTHETICS, PHENOTHIAZINES, OTHER TRANQUILIZERS (SEE ), SEDATIVEHYPNOTICS (INCLUDING
BARBITURATES), TRICYCLIC ANTIDEPRESSANTS AND OTHER CNS DEPRESSANTS (INCLUDING
ALCOHOL). RESPIRATORY DEPRESSION, HYPOTENSION AND PROFOUND SEDATION OR COMA MAY
RESULT.
The respiratory depressant effects of meperidine and its capacity
to elevate cerebrospinal fluid pressure may be markedly exaggerated in the
presence of head injury, other intracranial lesions or a preexisting increase in
intracranial pressure. Furthermore, narcotics produce adverse reactions which
may obscure the clinical course of patients with head injuries. In such
patients, meperidine must be used with extreme caution and only if its use is
deemed essential.
If necessary, meperidine may be given intravenously, but the
injection should be given very slowly, preferably in the form of a diluted
solution. Rapid intravenous injection of narcotic analgesics, including
meperidine, increases the incidence of adverse reactions; severe respiratory
depression, apnea, hypotension, peripheral circulatory collapse and cardiac
arrest have occurred. Meperidine should not be administered intravenously unless
a narcotic antagonist and the facilities for assisted or controlled respiration
are immediately available. When meperidine is given parenterally, especially
intravenously, the patient should be lying down.
Meperidine should be used with extreme caution in patients having
an acute asthmatic attack, patients with chronic obstructive pulmonary disease
or cor pulmonale, patients having a substantially decreased respiratory reserve
and patients with preexisting respiratory depression, hypoxia or hypercapnia. In
such patients, even usual therapeutic doses of narcotics may decrease
respiratory drive while simultaneously increasing airway resistance to the point
of apnea.
The administration of meperidine may result in severe hypotension
in the postoperative patient or any individual whose ability to maintain blood
pressure has already been compromised by a depleted blood volume or
administration of drugs, such as the phenothiazines or certain
anesthetics.
Meperidine may impair the mental and/or physical abilities
required for the performance of potentially hazardous tasks such as driving a
car or operating machinery. The patient should be cautioned accordingly.
Meperidine, like other narcotics, may produce orthostatic hypotension in
ambulatory patients.
Meperidine should not be used in pregnant women prior to the
labor period, unless in the judgment of the physician the potential benefits
outweigh the possible hazards, because safe use in pregnancy prior to labor has
not been established relative to possible adverse effects on fetal
development.
When used as an obstetrical analgesic, meperidine crosses the placental
barrier and can produce depression of respiration and psychophysiologic
functions in the newborn. Resuscitation may be required (see section on ).
Meperidine appears in the milk of nursing mothers receiving the drug.
What might happen if I take too much Meperidine Hydrochloride?
Serious overdose with meperidine is characterized by respiratory
depression (a decrease in respiratory rate and/or tidal volume, Cheyne-Stokes
respiration, cyanosis), extreme somnolence progressing to stupor or coma,
skeletal muscle flaccidity, cold and clammy skin and sometimes bradycardia and
hypotension. In severe overdosage, particularly by the intravenous route, apnea,
circulatory collapse, cardiac arrest and death may occur.
Primary attention should be given to the reestablishment of
adequate respiratory exchange through provision of a patent airway and
institution of assisted or controlled ventilation. The narcotic antagonist
naloxone hydrochloride is a specific antidote against respiratory depression
which may result from overdosage or unusual sensitivity to narcotics, including
meperidine. Therefore, an appropriate dose of naloxone hydrochloride should be
administered, preferably by the intravenous route, simultaneously with efforts
at respiratory resuscitation.
An antagonist should not be administered in the absence of clinically
significant respiratory or cardiovascular depression. Oxygen, intravenous
fluids, vasopressors and other supportive measures should be employed as
indicated.
NOTE: In an individual physically dependent on narcotics, the administration
of the usual dose of a narcotic antagonist will precipitate an acute withdrawal
syndrome. The severity of this syndrome will depend on the degree of physical
dependence and the dose of antagonist administered. The use of narcotic
antagonists in such individuals should be avoided if possible. If a narcotic
antagonist must be used to treat serious respiratory depression in the
physically dependent patient, the antagonist should be administered with extreme
care and only one-fifth to one-tenth the usual initial dose administered.
How should I store and handle Meperidine Hydrochloride?
Store at 20°-25°C (68°-77°F) (see USP Controlled Room Temperature). PROTECT FROM LIGHT. KEEP TIGHTLY CLOSED. Sarafem is a registered trademark of Eli Lilly and Company. Meperidine Hydrochloride Injection, USP is available in the following packages:50 mg/mL1 mL DOSETTE vials packaged in 25s ( )Store at 20°-25°C (68°-77°F), excursions permitted to 15°-30°C (59°-86°F) [see USP Controlled Room Temperature].Meperidine Hydrochloride Injection, USP is available in the following packages:50 mg/mL1 mL DOSETTE vials packaged in 25s ( )Store at 20°-25°C (68°-77°F), excursions permitted to 15°-30°C (59°-86°F) [see USP Controlled Room Temperature].Meperidine Hydrochloride Injection, USP is available in the following packages:50 mg/mL1 mL DOSETTE vials packaged in 25s ( )Store at 20°-25°C (68°-77°F), excursions permitted to 15°-30°C (59°-86°F) [see USP Controlled Room Temperature].Meperidine Hydrochloride Injection, USP is available in the following packages:50 mg/mL1 mL DOSETTE vials packaged in 25s ( )Store at 20°-25°C (68°-77°F), excursions permitted to 15°-30°C (59°-86°F) [see USP Controlled Room Temperature].