Source:http://www4.wiwiss.fu-berlin.de/dailymed/resource/drugs/2310
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Meperidine Hydrochloride (Injection)
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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. Meperidine is less effective orally than by parenteral
administration. The dose of meperidine should beproportionately
reduced (usually by 25 to 50 percent) when administered
concomitantly with phenothiazines and many other tranquilizers
since they potentiate the action of meperidine.<br/>Adults: The
usual dosage is 50 to 150 mg intramuscularly or
subcutaneously every 3 to 4 hours as necessary. Elderly
patients should usually be given meperidine at the lower
end of the dose range and observed closely.<br/>Children: The
usual dosage is 0.5 to 0.8 mg/lb intramuscularly or
subcutaneously up to the adult dose, every 3 to 4 hours as necessary.<br/>For Preoperative
Medication:<br/>Adults: The
usual dosage is 50 to 150 mg intramuscularly or
subcutaneously every 3 to 4 hours as necessary. Elderly
patients should usually be given meperidine at the lower
end of the dose range and observed closely.<br/>Children: The
usual dosage is 0.5 to 1 mg/lb intramuscularly or
subcutaneously up to the adult dose, 30 to 90 minutes
before the beginning of anesthesia.<br/>For Support of
Anesthesia: Repeated
slow intravenous injections of fractional doses (e.g., 10 mg/mL)
or by a 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.<br/>For Obstetrical
Analgesia: The usual
dosage is 50 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 matter and discoloration
prior to administration, whenever solution and container
permit.
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dailymed-instance:descripti... |
Meperidine
Hydrochloride Injection, USP is a sterile solution for intramuscular,
subcutaneous or slow intravenous use as a narcotic analgesic. Each mL of the
DOSETTE vial contains meperidine hydrochloride, either 25 mg, 50 mg, 75
mg or 100 mg in Water for Injection. Buffered with acetic acid-sodium
acetate. pH 3.5-6.0. Meperidine
hydrochloride is ethyl 1-methyl-4-phenylisonipecotate hydrochloride, a
white crystalline substance with a melting point of
186��-189��C. It is readily soluble in water and has a
slightly bitter taste. Its structural formula is as follows:
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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 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, 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:activeIng... | |
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.
Inother 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 andvital 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
meperidine hydrochloride and barbiturates are chemically
incompatible.
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dailymed-instance:supply |
Meperidine
Hydrochloride Injection, USP is available in the following packages: 25 mg/mL 1 mL DOSETTE vials
packaged in 25s ( NDC10019-159-01) 50 mg/mL 1 mL DOSETTE vials
packaged in 25s ( NDC10019-160-01) 75 mg/mL 1 mL DOSETTE vials
packaged in 25s ( NDC10019-161-01) 100 mg/mL 1 mL DOSETTE vials
packaged in 25s ( NDC10019-162-01)<br/>Storage: Store at 20��-25��C
(68��-77��F), excursions permitted to
15��-30��C (59��-86��F) [see
USP Controlled Room Temperature].
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dailymed-instance:precautio... |
As with all
intramuscular preparations, meperidine intramuscular injection should be
injected well within the body of a large muscle.<br/>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.<br/>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.<br/>Acute Abdominal
Conditions: The
administration of meperidine or other narcotics may obscure the
diagnosis or clinical course in patients with acute abdominal
conditions.<br/>Special Risk
Patients: Meperidine
should be given with caution and the initial dose should be
reduced in certain patients such as the elderly or 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 meperidine 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. Doses of meperidine
should be reduced in elderly patients. (See DOSAGE AND
ADMINISTRATION.) Sedating
drugs may cause confusion and oversedation in the elderly;
elderly patients generally should be started on low doses of
meperidine and observed closely. This drug
is known to be substantially 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
overdose 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.<br/>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 naloxone hydrochloride 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 |
Meperidine Hydrochloride (Injection)
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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: Central 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, palpitations, hypotension , syncope, phlebitis following intravenous
injection. Genitourinary-Urinary retention. Allergic-Pruritus, urticaria, other skin
rashes, wheal and flare over the vein with IV injection. Other-Pain at injection site; local
tissue irritation and induration following subcutaneous injection,
particularly when repeated; antidiuretic effect.
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dailymed-instance:warning |
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. 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.<br/>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), SEDATIVEHYPNOTICS (INCLUDING
BARBITURATES), TRICYCLIC ANTIDEPRESSANTS AND OTHER CNS
DEPRESSANTS (INCLUDING ALCOHOL). RESPIRATORY DEPRESSION,
HYPOTENSION AND PROFOUND SEDATION OR COMA MAY
RESULT.<br/>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.<br/>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.<br/>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 narcoticsmay decrease
respiratory drive while simultaneously increasing airway
resistance to the point of apnea.<br/>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 already been compromised by a
depleted blood volume or administration of drugs, such as the
phenothiazines or certain anesthetics.<br/>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.<br/>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 . 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:routeOfAd... | |
dailymed-instance:name |
Meperidine Hydrochloride
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