Source:http://www4.wiwiss.fu-berlin.de/dailymed/resource/drugs/1750
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Demerol (Injection, Solution)
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dailymed-instance:dosage |
For Relief of Pain 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. The
dose of Demerol 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 Demerol. Adults. The usual dosage is 50 mg to 150 mg
intramuscularly or subcutaneously every 3 or 4 hours as necessary. Elderly
patients should usually be given meperidine at the lower end of the dose range
and observed closely. Children. The usual dosage is 0.5 mg/lb to 0.8 mg/lb intramuscularly or
subcutaneously up to the adult dose, every 3 or 4 hours as necessary. For Preoperative Medication Adults. The usual dosage is 50 mg to 100 mg
intramuscularly or subcutaneously, 30 to 90 minutes before the beginning of
anesthesia. Elderly patients should usually be given meperidine at the lower
end of the dose range and observed closely. Children. The usual dosage is 0.5 mg/lb to 1
mg/lb intramuscularly or subcutaneously up to the adult dose, 30 to 90 minutes
before the beginning of anesthesia. For
Support of Anesthesia Repeated slow intravenous
injections of fractional doses (e.g., 10 mg/mL) or 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. For Obstetrical
Analgesia The usual dosage is 50 mg 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 and discoloration prior
to administration whenever solution and container permit.
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dailymed-instance:descripti... |
Meperidine hydrochloride is ethyl 1-methyl-4-phenylisonipecotate
hydrochloride, a white crystalline substance with a melting point of 186��C
to 189��C. It is readily soluble in water and has a neutral reaction and
a slightly bitter taste. The solution is not decomposed by a short period
of boiling. Demerol injectable is supplied in Carpuject, CARPUJECT with InterLink, CARPUJECT with Luer Lock and CARPUJECT with
blunt cannula of 2.5% (25 mg/1 mL), 5% (50 mg/1 mL), 7.5% (75 mg/1 mL), and
10% (100 mg/1 mL). Uni-Amp' unit dose pak-ampuls of 5% solution (25 mg/0.5 mL), (50 mg/1 mL), (75 mg/1.5 mL), (100 mg/2 mL), and 10% solution (100 mg/1 mL).
Multiple-dose vials of 5% and 10% solutions contain metacresol 0.1% as preservative. The
pH of Demerol solutions is adjusted between 3.5 and 6 with sodium hydroxide
or hydrochloric acid. Demerol, brand of meperidine hydrochloride,
5 percent solution has a specific gravity of 1.0086 at 20��C and
10 percent solution, a specific gravity of 1.0165 at 20��C.
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dailymed-instance:clinicalP... |
Meperidine hydrochloride is a narcotic analgesic with multiple
actions qualitatively similar to those of morphine; the most prominent of
these involve the central nervous system and organs composed of smooth muscle.
The principal actions of therapeutic value are analgesia and sedation. There
is some evidence which suggests that meperidine may produce less smooth muscle
spasm, constipation, and depression of the cough reflex than equianalgesic
doses of morphine. Meperidine, in 60 mg to 80 mg parenteral doses, is approximately
equivalent in analgesic effect to 10 mg of morphine. The onset of action is
slightly more rapid than with morphine, and the duration of action is slightly
shorter. Meperidine is significantly less effective by the oral than by the
parenteral route, but the exact ratio of oral to parenteral effectiveness
is unknown. In clinical studies reported in the literature,
changes in several pharmacokinetic parameters with increasing age have been
observed. The initial volume of distribution and steady-state volume of distribution
may be higher in elderly patients than in younger patients. The free fraction
of meperidine in plasma may be higher in patients over 45 years of age than
in younger patients.
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dailymed-instance:contraind... |
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 Demerol and barbiturates are chemically incompatible.
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dailymed-instance:supply |
For Parenteral Use Solutions
of Demerol for parenteral use are clear and colorless and are available as
follows: Carpujects are packaged in either the Detecto-Seal or
Slim-Pak���tamper detection package. To prevent
needle - stick injuries, needles should not be recapped, purposely bent, or
broken by hand. Blunt Cannulas should not be recapped, purposely bent or broken
by hand. Demerol in the Blunt Cannula or InterLink' configuration is
not intended for intramuscular (IM) use. Note: The pH
of Demerol solutions is adjusted between 3.5 and 6 with sodium hydroxide or
hydrochloric acid. Multiple-dose vials contain metacresol 0.1 percent as preservative.
No preservatives are added to the ampuls or CARPUJECT sterile cartridge units. Store
at 20 to 25��C (68 to 77��F). [See USP Controlled Room Temperature.] Demerol
is a registered trademark of Sanofi Pharmaceuticals Inc. InterLink'
is a Trademark of Baxter International, Inc. U.S. Pat.
Nos. 5,158,554; 5,171,234; 5,188,620; Pat. Pending Rev:
January, 2005 ��Hospira 2005 EN-0822 Printed in
USA HOSPIRA, INC., LAKE
FOREST, IL 60045 USA
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dailymed-instance:precautio... |
As with all intramuscular preparations, Demerol intramuscular
injection should be injected well within the body of a large muscle. Supraventricular Tachycardias. 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. Convulsions. 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. Acute Abdominal Conditions. The administration
of meperidine or other narcotics may obscure the diagnosis or clinical course
in patients with acute abdominal conditions. Special Risk Patients. Meperidine should be
given with caution and the initial dose should be reduced in certain patients
such as the debilitated, and those with severe impairment of hepatic or renal
function, hypothyroidism, Addison's disease, and prostatic hypertrophy
or urethral stricture.<br/>Geriatric Use.: Clinical studies of Demerol 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. (See DOSAGE AND ADMINISTRATION.) Sedating drugs
may cause confusion and oversedation in the elderly; elderly patients generally
should be started on low doses of Demerol and observed closely. This
drug is known to be 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 CLINICAL PHARMACOLOGY.)
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dailymed-instance:overdosag... |
Symptoms. Serious
overdosage 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. Treatment. 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 this antagonist 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.
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dailymed-instance:genericMe... |
Meperidine Hydrochloride
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dailymed-instance:fullName |
Demerol (Injection, Solution)
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dailymed-instance:adverseRe... |
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: Nervous
System. Euphoria, dysphoria, weakness, headache, agitation, tremor,
uncoordinated muscle movements, severe convulsions, transient hallucinations
and disorientation, visual disturbances. Inadvertent injection about a nerve
trunk may result in sensory-motor paralysis which is usually, though not always,
transitory. Gastrointestinal. Dry mouth, constipation, biliary tract spasm. Cardiovascular. Flushing of the face, tachycardia,
bradycardia, palpitation, hypotension (see WARNINGS), syncope, phlebitis following
intravenous injection. Genitourinary. Urinary retention. Allergic. Pruritus, urticaria, other skin rashes, wheal and flare over the
vein with intravenous injection. Other. Pain at injection site; local tissue irritation and induration
following subcutaneous injection, particularly when repeated; antidiuretic
effect.
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Drug Dependence. 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, and 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. Interaction
with Other Central Nervous System Depressants. 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 DOSAGE AND ADMINISTRATION), SEDATIVE-HYPNOTICS (INCLUDING
BARBITURATES), TRICYCLIC ANTIDEPRESSANTS AND OTHER CNS DEPRESSANTS (INCLUDING
ALCOHOL). RESPIRATORY DEPRESSION, HYPOTENSION, AND PROFOUND SEDATION OR COMA
MAY RESULT. Head Injury
and Increased Intracranial Pressure. 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. Intravenous Use. 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. Asthma and Other Respiratory Conditions. 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. Hypotensive Effect. The administration of meperidine
may result in severe hypotension in the postoperative patient or any individual
whose ability to maintain blood pressure has been compromised by a depleted
blood volume or the administration of drugs such as the phenothiazines or
certain anesthetics. Usage
in Ambulatory Patients. 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. Usage in Pregnancy and Lactation. 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 OVERDOSAGE). Meperidine
appears in the milk of nursing mothers receiving the drug.
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dailymed-instance:indicatio... |
For the relief of moderate to severe pain For
preoperative medication For support of anesthesia For
obstetrical analgesia
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dailymed-instance:name |
Demerol
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