Brand Name: Demerol Pregnancy Category C, C-II controlled substance Drug class: Opioid agonist analgesic

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 Relief of moderate to severe acute pain (oral, parenteral) Preoperative medication, support of anesthesia, and obstetric analgesia (parenteral) Contraindications and cautions Contraindicated with hypersensitivity to narcotics, 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 dysfunction. 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 (narcotics given to the mother can cause respiratory depression of neonate; premature infants are especially at risk), renal or hepatic dysfunction.

Adverse effects 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 Facial flushing, peripheral circulatory collapse, tachycardia, bradycardia, arrhythmia, palpitations, chest wall rigidity, hypertension, hypotension, orthostatic hypotension, syncope Pruritus, urticaria, laryngospasm, bronchospasm, edema Nausea, vomiting, dry mouth, anorexia, constipation, biliary tract spasm, increased colonic motility in patients with chronic ulcerative colitis Ureteral spasm, spasm of vesical sphincters, urinary retention or hesitancy, oliguria, antidiuretic effect, reduced libido or potency Tissue irritation and induration (SC injection) Respiratory depression, apnea, circulatory depression, respiratory arrest, shock, cardiac arrest Sweating, physical tolerance and dependence, psychological dependence

Drug Interactions: Potentiation of effects with barbiturate anesthetics; decrease dose of meperidine when coadministering Severe and sometimes fatal reactions (resembling narcotic overdose; characterized by seizures, hypertension, hyperpyrexia) when given to patients receiving or who have recently received MAOIs; do not give meperidine to patients on MAOIs Increased likelihood of respiratory depression, hypotension, profound sedation, or coma with phenothiazines

Nursing considerations Administer to lactating women 46 hr before the next feeding to minimize the amount in milk. Provide narcotic antagonist, facilities for assisted or controlled respiration on standby during parenteral administration. Use caution when injecting SC 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 about addiction liability; most patients who receive opiates for medical reasons do not develop dependence syndromes. Use meperidine with extreme caution in patients with renal dysfunction or those requiring repeated dosing due to accumulation of normeperidine, a toxic metabolite that may cause seizures.