Nurses Compass
Drug Guide
Meperidine Hydrochloride
Classification
Therapeutic: Analgesic
Pharmacological: Opioid Agonist
FDA Approved Indications
- Moderate to severe pain
Mechanism of Action
Meperidine binds to mu-opioid receptors in the central nervous system, altering the perception and response to pain, and producing analgesia, sedation, and euphoria.
Dosage and Administration
Adult: 25-50 mg every 3-4 hours as needed; maximum dose varies depending on clinical scenario but generally not exceeding 600 mg per day.
Pediatric: Dosing based on weight; typically 1-1.5 mg/kg every 3-4 hours as needed, not to exceed adult dose.
Geriatric: Start at lower end of dosing range, monitor closely due to increased sensitivity and risk of adverse effects.
Renal Impairment: Use with caution; dose adjustments may be necessary due to accumulation of active metabolites.
Hepatic Impairment: Use with caution; monitor for increased sedation and toxicity.
Pharmacokinetics
Absorption: Rapidly absorbed after IM, subcutaneous, or oral administration.
Distribution: Widely distributed; crosses blood-brain barrier and placenta.
Metabolism: Largely hepatic metabolism; metabolized to normeperidine, an active and toxic metabolite.
Excretion: Renal elimination of parent drug and metabolites.
Half Life: Approximately 3-5 hours for meperidine; 15-30 hours for normeperidine.
Contraindications
- Severe respiratory depression
- Acute or severe asthma
- Known hypersensitivity to opioids
Precautions
- Use with caution in elderly, hepatic or renal impairment
- History of seizures or concurrent use of serotonergic drugs (risk of serotonin syndrome)
- Risk of dependency, abuse, and addiction
Adverse Reactions - Common
- Dizziness (Common)
- Sedation (Common)
- Nausea (Common)
- Vomiting (Common)
Adverse Reactions - Serious
- Respiratory depression (Serious)
- Seizures (Serious (especially with normeperidine accumulation))
- Serotonin syndrome (Serious when combined with serotonergic agents)
Drug-Drug Interactions
- Monoamine oxidase inhibitors (may increase the risk of serious adverse reactions)
- Serotonergic drugs (SSRIs, SNRIs) due to serotonin syndrome risk
- CNS depressants (enhanced sedative effects)
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor respiratory status, level of sedation, and pain relief.
Diagnoses:
- Impaired respiratory function
- Risk for injury related to sedation and dizziness
Implementation: Administer drug as prescribed, monitor patient response, and assess pain levels. Be vigilant for signs of respiratory depression.
Evaluation: Assess effectiveness of pain relief and monitor for adverse effects.
Patient/Family Teaching
- Do not operate heavy machinery or drive until sedation wears off.
- Report any signs of difficulty breathing, excessive sedation, or allergic reactions.
- Avoid alcohol and other CNS depressants.
- Take medication exactly as prescribed.
Special Considerations
Black Box Warnings:
- Respiratory depression can be life-threatening.
- Risk of abuse and dependence.
Genetic Factors: Genetic variability can affect metabolism and response.
Lab Test Interference: None known.
Overdose Management
Signs/Symptoms: Respiratory depression, pinpoint pupils, unconsciousness, hypotension.
Treatment: Administer opioid antagonist naloxone, provide supportive respiratory and cardiovascular care, ventilatory support if necessary.
Storage and Handling
Storage: Store in a tightly closed container at controlled room temperature, away from light and moisture.
Stability: Stable under recommended conditions; check expiration date before use.