Meperidine

Synonym :

Pethidine

Mechanism :

It is a narcotic analgesic used as an adjunct in anesthesia and for analgesia.

Indication :

Moderate to severe pain
Pre-operative sedation

Contraindications :

Hypersensitivity to drug/class/component.

MAO inhibitor use w/in 14 days, severe Respiratory depression, Avoid abrupt withdrawal (prolonged or long-term use).

Caution if: Pulmonary impairment, cor pulmonale, Asthma or COPD, respiratory depression, head injury or intracranial lesion, ICP incr., CNS depression, seizure disorder, SVT, hypotension, acute abdomen, prostatic hypertrophy or urethral stricture, adrenal insufficiency, hypothyroidism, substance abuse, acute alcoholism, sickle cell anemia, pheochromocytoma, delirium tremens, toxic psychosis. Prolonged use in infants/neonates not recommended.

Dosing :

1-1.75 mg/kg PO/SC/IM every 3-4 hours. Max:

100 mg/dose.

Preoperatively:

1.1-2.2 mg/kg IM/SC half to 1.5 hours before anaesthesia.

Adverse Effect :

Dependence, CNS and respiratory depression, seizures, nausea, vomiting, ileus, hypotension, bradycardia, urinary retention, allergic reactions, drowsiness.

Interaction :

CNS depression, CYP2B6 substrate, CYP3A4 substrate, GI absorption enhanced by GLP-2 receptor agonist: Anticholinergic-like effects, lowers seizure threshold, weak serotonergic effects.
Contraindicated:
Isocarboxazid, Morphine Liposomal, Phenelzine, Procarbazine, Rasagiline, Selegiline, Selegiline Transdermal, Tranylcypromine.

Renal Dose :

Dose in Renal Impairment GFR (mL/min)

20-50	Dose as in normal renal function
10-20	Use small doses – increase dosing interval to 6 hours and decrease dose by 25%
<10	Avoid if possible. If not, use small doses: increase dosing interval to 8 hours and decrease dose by 50%

Dose in Patients undergoing Renal Replacement Therapies

CAPD	Unknown dialysability. Dose as in GFR<10 mL/min
HD	Not dialysed. Dose as in GFR<10 mL/min
HDF/High flux	Unknown dialysability. Dose as in GFR<10 mL/min
CAV/VVHD	Unlikely dialysability. Dose as in GFR=10–20 mL/min

Hepatic Dose :

Use with caution and reduce dose; accumulation of meperidine and its active metabolite (normeperidine) may occur.