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(meh-PEHR-ih-deen HIGH-droe-KLOR-ide)
Demerol HCl
Class: Narcotic analgesic

 Action Relieves pain by stimulating opiate receptors in CNS; also causes respiratory depression, peripheral vasodilation, inhibition of intestinal peristalsis, sphincter of Oddi spasm, stimulation of chemoreceptors that cause vomiting and increased bladder tone.

 Indications

Oral and parenteral: Relief of moderate-to-severe pain. Parenteral: Preoperative sedation; support of anesthesia; obstetrical analgesia.

 Contraindications Upper airway obstruction; acute asthma; diarrhea due to poisoning or toxins; patients who are receiving or have received MAO inhibitor within last 14 days.

 Route/Dosage

Pain

ADULTS: IM/SC/PO 50 to 150 mg q 3 to 4 hr prn. If IV administration is required, reduce dose and administer slowly. CHILDREN: IM/SC/PO 1 to 1.8 mg/kg (up to adult dose) q 3 to 4 hr prn.

Preoperative Sedation

ADULTS: IM/SC 50 to 100 mg 30 to 90 min before anesthetic. CHILDREN: IM/SC 1 to 2 mg/kg (0.5 to 1 mg/lb), up to adult dose, 30 to 90 min before beginning anesthsia.

Support of Anesthesia

ADULTS: IV Repeated doses diluted to 10 mg/ml by slow injection or by continuous infusion diluted to 1 mg/ml.

Obstetrical Analgesia

ADULTS: IM/SC 50 to 100 mg q 1 to 3 hr prn when pains become regular.

 Interactions

CNS depressants (eg, tranquilizers, sedatives, alcohol): Additive CNS depression. Cimetidine: Monitor for increased respiratory and CNS depression. Hydantoins: Hydantoins may decrease the pharmacologic effects of meperidine, possibly because of increased hepatic metabolism of the narcotic. MAO inhibitors, furazolidone: Potentially fatal reactions can occur if meperidine is used in patients within 14 days of receiving MAO inhibitor or furazolidone. Phenothiazines: Excessive sedation and hypotension. INCOMPATIBILITIES: Do not co-infuse with solutions of soluble barbiturates, aminophylline, heparin, morphine, methicillin, phenytoin, sodium bicarbonate, iodine, sulfadiazine and sulfisoxazole.

 Lab Test Interferences Increased amylase and lipase may occur up to 24 hr after dose.

 Adverse Reactions

CV: Hypotension; orthostatic hypotension; bradycardia; tachycardia. CNS: Lightheadedness; dizziness; sedation; disorientation; incoordination; eizures. DERM: Sweating; pruritus; urticaria. GI: Nausea; vomiting; constipation; abdominal pain. GU: Urinary retention or hesitancy. RESP: Respiratory depression; laryngospasm; depression of cough reflex.

 Precautions

Pregnancy: Pregnancy category undetermined. Safety not established. Lactation: Excreted in breast milk. Special risk patients: Use with caution in patients with myxedema, acute alcoholism, acute abdominal conditions, ulcerative colitis, decreased respiratory reserve, head injury or increased intracranial pressure, hypoxia, supraventricular tachycardia, depleted blood volume, circulatory shock or renal dysfunction. Drug dependence: Tolerance and psychological and physical dependence may occur with chronic use. Hepatic or renal impairment: Dosage reduction may be necessary. Neurotoxicity: Can cause dysphoria, hallucinations and seizures in patients with renal impairment or with chronic high-dose therapy. Sulfite sensitivity: Some parenteral products contain sulfites; may cause allergic-type reactions in susceptible individuals.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Administer as soon as pain occurs or prophylactically 30 min before painful procedures. Effect is reduced as pain severity increases.
  • Administer meperidine syrup with half glass of water to avoid anesthetizing oral mucous membranes.
  • Give oral preparations with food if stomach upset occurs.
  • IM administration is preferred for repeated doses.
  • Prepare IV injection or solution by diluting in 5% Dextrose and Lactated Ringer’s; Dextrose-Saline combinations; 2.5%, 5%, or 10% Dextrose in Water; Lactated Ringer’s or Ringer’s; 0.45% or 0.9% Sodium Chloride; or 1/6; Molar Sodium Lactate.
  • Administer direct IV over at least 3 min.
  • Place patient in reclining position and institute safety measures before administering parenteral medication.
  • Do not administer if solution is cloudy or if precipitate is present.
  • Do not administer IV solution if antidote is not readily available.
  • Store at room temperature in tightly closed, light-resistant container.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Reduce environmental stimuli and provide maximum comfort measures before administration.
  • Obtain vital signs before administration. If respirations are diminished (or 12 breaths/min), withhold medication and notify physician.
  • Reassess vital signs 30 min after administration (5–10 min after direct IV administration).
  • Assess bowel and bladder function regularly in patients receiving repeated dosages.
  • Encourage coughing and deep breathing exercises q 2 hr while awake.
OVERDOSAGE: SIGNS & SYMPTOMS
  Miosis, respiratory and CNS depression, circulatory collapse, seizures, cardiopulmonary arrest, death

 Patient/Family Education

  • Instruct patient that if dose is missed, it should be taken as soon as possible unless close to time of next dose. Do not double up doses.
  • If medication is given long term, explain that dosage will be tapered gradually before stopping to prevent withdrawal symptoms.
  • Instruct patient not to wait until pain level is high to self-medicate, because drug will not be as effective.
  • Encourage increased fluid intake and moderate exercise to prevent constipation. Stool softeners or fiber laxative may also be used.
  • Advise patient to use humidifier to liquefy secretions. Teach deep breathing exercises.
  • Instruct patient to avoid sudden position changes to avoid orthostatic hypotension.
  • Tell patient to avoid intake of alcoholic beverages or other CNS depressants (eg, sleeping pills, antihistamines).
  • Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.

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