meperidine (Rx)

Brand and Other Names:Demerol, pethidine
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

syrup: Schedule II

  • 50mg/5mL

tablet: Schedule II

  • 50mg
  • 100mg

injectable solution: Schedule II

  • 25mg/mL
  • 50mg/mL
  • 75mg/mL
  • 100mg/mL

Pain

Meperidine is not recommended as a first choice analgesic by The American Pain Society and ISMP (2007); if no other options, limit use in acute pain to ≤48hr; doses should not exceed 600 mg/24hr; oral route is not recommended for treatment of acute or chronic pain

Pain: 50-150 mg PO/IM/SC q3-4hr PRN; adjust dose based degree of response

Preoperatively: 50-100 mg IM/SC 30-90 min before beginning anesthesia

Continuous infusion: 15-35 mg/hr

Obstetrical analgesia: 50-100 mg IM/SC; repeated q1-3hr PRN

Dosing Modifications

Renal impairment: Avoid use

Hepatic impairment: Consider lower initial dose intially; increased opioid effect possible in cirrhosis

Dosing Considerations

Access to naloxone for opioid overdose

  • Assess need for naloxone upon initiating and renewing treatment
  • Consider prescribing naloxone
    • Based on patient’s risk factors for overdose (eg, concomitant use of CNS depressants, a history of opioid use disorder, prior opioid overdose); presence of risk factors should not prevent proper pain management
    • Household members (including children) or other close contacts at risk for accidental ingestion or overdose
  • Consult patients and caregivers on the following:
    • Availability of naloxone for emergency treatment of opioid overdose
    • Ways differ on how to obtain naloxone as permitted by individual state dispensing and prescribing requirements or guidelines (eg, by prescription, directly from a pharmacist, as part of a community-based program)

Limitations of Use

  • Because of risks of addiction, abuse, and misuse with opioids, even at recommended doses, reserve therapy for use in patients for whom alternative treatment options [eg, non-opioid analgesics] have not been tolerated, or are not expected to be tolerated, have not provided adequate analgesia, or are not expected to provide adequate analgesia

Dosage Forms & Strengths

syrup: Schedule II

  • 50mg/5mL

tablet: Schedule II

  • 50mg
  • 100mg

injectable solution: Schedule II

  • 25mg/mL
  • 50mg/mL
  • 75mg/mL
  • 100mg/mL

Pain

Meperidine is not recommended as a first choice analgesic by The American Pain Society and ISMP (2007); if no other options, limit use in acute pain to ≤48hr; doses should not exceed 600 mg/24hr; oral route is not recommended for treatment of acute or chronic pain

1-1.8 mg/kg PO/IM/SC q3-4hr PRN; individual dose not to exceed 100 mg  

Preoperatively: 1.1-2.2 mg/kg IM/SC 30-90 minutes before initiation of anesthesia

Pain

50 mg PO q4hr or 25 mg IM q4hr; treatment for acute pain should be limited to 1-2 doses

Dosing Considerations

Not drug of choice in elderly patients, because of accumulation of metabolite normeperidine, causing increased central nervous system (CNS) effects

Reduce total daily dose in elderly patients

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Interactions

Interaction Checker

and meperidine

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            Contraindicated (10)

            • alvimopan

              alvimopan, meperidine. receptor binding competition. Contraindicated. Alvimopan is contraindicated in opioid tolerant patients (ie, those who have taken therapeutic doses of opioids for >7 consecutive days immediately prior to taking alvimopan). Patients recently exposed to opioids are expected to be more sensitive to the effects of alvimopan and therefore may experience abdominal pain, nausea and vomiting, and diarrhea. No significant interaction is expected with concurrent use of opioid analgesics and alvimopan in patients who received opioid analgesics for 7 or fewer consecutive days prior to alvimopan.

            • isocarboxazid

              isocarboxazid and meperidine both increase serotonin levels. Contraindicated.

              isocarboxazid increases toxicity of meperidine by unknown mechanism. Contraindicated.

            • linezolid

              linezolid increases toxicity of meperidine by unknown mechanism. Contraindicated.

            • phenelzine

              phenelzine and meperidine both increase serotonin levels. Contraindicated.

              phenelzine increases toxicity of meperidine by unknown mechanism. Contraindicated.

            • procarbazine

              procarbazine and meperidine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

              procarbazine increases toxicity of meperidine by unknown mechanism. Contraindicated. MAOIs may potentiate CNS depression and hypotension. Do not use meperidine within 14 days of MAOI use. .

            • rasagiline

              rasagiline and meperidine both increase serotonin levels. Contraindicated. Risk of serious, sometimes fatal reactions from serotonin syndrome.

            • safinamide

              meperidine, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.

            • selegiline

              selegiline and meperidine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of selegiline and initiation of analgesic.

            • selegiline transdermal

              selegiline transdermal increases toxicity of meperidine by unknown mechanism. Contraindicated.

            • tranylcypromine

              tranylcypromine and meperidine both increase serotonin levels. Contraindicated.

              tranylcypromine increases toxicity of meperidine by unknown mechanism. Contraindicated.

            Serious - Use Alternative (59)

            • amitriptyline

              amitriptyline and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

            • amoxapine

              amoxapine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

            • benzhydrocodone/acetaminophen

              benzhydrocodone/acetaminophen, meperidine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • buprenorphine

              buprenorphine, meperidine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • buprenorphine buccal

              buprenorphine buccal, meperidine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • buspirone

              buspirone and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

            • butorphanol

              butorphanol, meperidine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • calcium/magnesium/potassium/sodium oxybates

              meperidine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • cimetidine

              cimetidine increases effects of meperidine by decreasing metabolism. Avoid or Use Alternate Drug.

            • citalopram

              meperidine, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • clomipramine

              clomipramine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

            • clonidine

              clonidine, meperidine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.

            • cyclobenzaprine

              meperidine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • desipramine

              desipramine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

            • desvenlafaxine

              meperidine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

            • dextromethorphan

              dextromethorphan and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

            • diazepam intranasal

              diazepam intranasal, meperidine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • doxepin

              doxepin and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

            • duloxetine

              duloxetine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

            • eluxadoline

              meperidine, eluxadoline. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that cause constipation. Increases risk for constipation related serious adverse reactions. .

            • escitalopram

              escitalopram and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

              meperidine, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • fentanyl

              fentanyl, meperidine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

            • fentanyl intranasal

              fentanyl intranasal, meperidine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

            • fentanyl transdermal

              fentanyl transdermal, meperidine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

            • fentanyl transmucosal

              fentanyl transmucosal, meperidine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

            • fluoxetine

              fluoxetine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

              meperidine, fluoxetine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • fluvoxamine

              fluvoxamine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

            • hydrocodone

              hydrocodone, meperidine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • imipramine

              imipramine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

            • levomilnacipran

              levomilnacipran and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

            • linezolid

              linezolid and meperidine both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.

              meperidine, linezolid. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • lofepramine

              lofepramine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

            • lorcaserin

              meperidine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

            • maprotiline

              maprotiline and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

            • methylene blue

              methylene blue and meperidine both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.

            • metoclopramide intranasal

              meperidine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

            • milnacipran

              milnacipran and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

            • nalbuphine

              nalbuphine, meperidine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • nefazodone

              nefazodone and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

            • nortriptyline

              nortriptyline and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

            • ozanimod

              ozanimod and meperidine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

            • paroxetine

              paroxetine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

              meperidine, paroxetine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • pentazocine

              pentazocine, meperidine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • protriptyline

              protriptyline and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

            • selegiline transdermal

              selegiline transdermal and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

            • selinexor

              selinexor, meperidine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

            • sertraline

              sertraline and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

              meperidine, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • sodium oxybate

              meperidine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • St John's Wort

              meperidine and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.

            • sufentanil SL

              sufentanil SL, meperidine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • tedizolid

              tedizolid, meperidine. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.

            • tipranavir

              tipranavir, meperidine. Mechanism: unspecified interaction mechanism. Avoid or Use Alternate Drug. Meperidine levels decrease, but metabolite normeperidine levels increase, increasing risk of seizure.

            • tramadol

              tramadol, meperidine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

            • trazodone

              trazodone and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

            • trimipramine

              trimipramine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

            • valerian

              valerian and meperidine both increase sedation. Avoid or Use Alternate Drug.

            • venlafaxine

              venlafaxine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

            • vilazodone

              meperidine, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .

            • vortioxetine

              meperidine, vortioxetine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            Monitor Closely (219)

            • 5-HTP

              5-HTP and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • albuterol

              meperidine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • alfentanil

              alfentanil and meperidine both increase sedation. Use Caution/Monitor.

            • almotriptan

              almotriptan and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • alprazolam

              alprazolam and meperidine both increase sedation. Use Caution/Monitor.

            • amifampridine

              meperidine increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

            • amitriptyline

              meperidine and amitriptyline both increase sedation. Use Caution/Monitor.

            • amobarbital

              amobarbital and meperidine both increase sedation. Use Caution/Monitor.

            • amoxapine

              meperidine and amoxapine both increase sedation. Use Caution/Monitor.

            • apomorphine

              meperidine and apomorphine both increase sedation. Use Caution/Monitor.

            • arformoterol

              meperidine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • aripiprazole

              meperidine and aripiprazole both increase sedation. Use Caution/Monitor.

              meperidine, aripiprazole. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • armodafinil

              meperidine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • asenapine

              meperidine, asenapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • atazanavir

              atazanavir increases levels of meperidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

            • azelastine

              azelastine and meperidine both increase sedation. Use Caution/Monitor.

            • baclofen

              baclofen and meperidine both increase sedation. Use Caution/Monitor.

            • belladonna and opium

              meperidine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • benperidol

              meperidine and benperidol both increase sedation. Use Caution/Monitor.

            • benzphetamine

              meperidine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • brexanolone

              brexanolone, meperidine. Either increases toxicity of the other by sedation. Use Caution/Monitor.

            • brompheniramine

              brompheniramine and meperidine both increase sedation. Use Caution/Monitor.

            • buprenorphine

              buprenorphine and meperidine both increase sedation. Use Caution/Monitor.

            • buprenorphine buccal

              buprenorphine buccal and meperidine both increase sedation. Use Caution/Monitor.

            • buprenorphine, long-acting injection

              meperidine increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

            • butabarbital

              butabarbital and meperidine both increase sedation. Use Caution/Monitor.

            • butalbital

              butalbital and meperidine both increase sedation. Use Caution/Monitor.

            • butorphanol

              butorphanol and meperidine both increase sedation. Use Caution/Monitor.

            • caffeine

              meperidine increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carbinoxamine

              carbinoxamine and meperidine both increase sedation. Use Caution/Monitor.

            • cariprazine

              meperidine, cariprazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • carisoprodol

              carisoprodol and meperidine both increase sedation. Use Caution/Monitor.

            • chloral hydrate

              chloral hydrate and meperidine both increase sedation. Use Caution/Monitor.

            • chlordiazepoxide

              chlordiazepoxide and meperidine both increase sedation. Use Caution/Monitor.

            • chlorpheniramine

              chlorpheniramine and meperidine both increase sedation. Use Caution/Monitor.

            • chlorpromazine

              meperidine and chlorpromazine both increase sedation. Use Caution/Monitor.

            • chlorzoxazone

              chlorzoxazone and meperidine both increase sedation. Use Caution/Monitor.

            • cinnarizine

              cinnarizine and meperidine both increase sedation. Use Caution/Monitor.

            • citalopram

              citalopram and meperidine both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

            • clemastine

              clemastine and meperidine both increase sedation. Use Caution/Monitor.

            • clobazam

              meperidine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

            • clomipramine

              meperidine and clomipramine both increase sedation. Use Caution/Monitor.

            • clonazepam

              clonazepam and meperidine both increase sedation. Use Caution/Monitor.

            • clorazepate

              clorazepate and meperidine both increase sedation. Use Caution/Monitor.

            • clozapine

              meperidine and clozapine both increase sedation. Use Caution/Monitor.

              meperidine, clozapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • cocaine

              cocaine and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • codeine

              codeine and meperidine both increase sedation. Use Caution/Monitor.

            • cyclizine

              cyclizine and meperidine both increase sedation. Use Caution/Monitor.

            • cyclobenzaprine

              cyclobenzaprine and meperidine both increase sedation. Use Caution/Monitor.

            • cyproheptadine

              cyproheptadine and meperidine both increase sedation. Use Caution/Monitor.

            • dantrolene

              dantrolene and meperidine both increase sedation. Use Caution/Monitor.

            • darunavir

              darunavir increases levels of meperidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

            • desflurane

              desflurane and meperidine both increase sedation. Use Caution/Monitor. Opioids may decrease MAC requirements, less inhalation anesthetic may be required.

            • desipramine

              meperidine and desipramine both increase sedation. Use Caution/Monitor.

            • deutetrabenazine

              meperidine and deutetrabenazine both increase sedation. Use Caution/Monitor.

            • dexchlorpheniramine

              dexchlorpheniramine and meperidine both increase sedation. Use Caution/Monitor.

            • dexfenfluramine

              meperidine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              dexfenfluramine and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • dexmedetomidine

              dexmedetomidine and meperidine both increase sedation. Use Caution/Monitor.

            • dexmethylphenidate

              meperidine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dextroamphetamine

              meperidine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              dextroamphetamine and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • dextromoramide

              dextromoramide and meperidine both increase sedation. Use Caution/Monitor.

            • diamorphine

              diamorphine and meperidine both increase sedation. Use Caution/Monitor.

            • diazepam

              diazepam and meperidine both increase sedation. Use Caution/Monitor.

            • diethylpropion

              meperidine increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • difenoxin hcl

              difenoxin hcl and meperidine both increase sedation. Use Caution/Monitor.

            • dihydroergotamine

              dihydroergotamine and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • dihydroergotamine intranasal

              dihydroergotamine intranasal and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • dimenhydrinate

              dimenhydrinate and meperidine both increase sedation. Use Caution/Monitor.

            • diphenhydramine

              diphenhydramine and meperidine both increase sedation. Use Caution/Monitor.

            • diphenoxylate hcl

              diphenoxylate hcl and meperidine both increase sedation. Use Caution/Monitor.

            • dipipanone

              dipipanone and meperidine both increase sedation. Use Caution/Monitor.

            • dobutamine

              meperidine increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dopamine

              meperidine increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dopexamine

              meperidine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dosulepin

              meperidine and dosulepin both increase sedation. Use Caution/Monitor.

            • doxepin

              meperidine and doxepin both increase sedation. Use Caution/Monitor.

            • doxylamine

              doxylamine and meperidine both increase sedation. Use Caution/Monitor.

            • droperidol

              meperidine and droperidol both increase sedation. Use Caution/Monitor.

            • efavirenz

              efavirenz will decrease the level or effect of meperidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased toxic metabolite formation.

            • eletriptan

              eletriptan and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • eltrombopag

              eltrombopag increases levels of meperidine by decreasing metabolism. Use Caution/Monitor. UGT inhibition; significance of interaction unclear.

            • ephedrine

              meperidine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • epinephrine

              meperidine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • epinephrine racemic

              meperidine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ergotamine

              ergotamine and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • esketamine intranasal

              esketamine intranasal, meperidine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

            • estazolam

              estazolam and meperidine both increase sedation. Use Caution/Monitor.

            • ethanol

              meperidine and ethanol both increase sedation. Use Caution/Monitor.

            • etomidate

              etomidate and meperidine both increase sedation. Use Caution/Monitor.

            • fenfluramine

              meperidine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              fenfluramine and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • flibanserin

              meperidine and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.

            • fluphenazine

              meperidine and fluphenazine both increase sedation. Use Caution/Monitor.

              meperidine, fluphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • flurazepam

              flurazepam and meperidine both increase sedation. Use Caution/Monitor.

            • formoterol

              meperidine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • fosamprenavir

              fosamprenavir increases levels of meperidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

            • frovatriptan

              frovatriptan and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • gabapentin

              gabapentin, meperidine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • gabapentin enacarbil

              gabapentin enacarbil, meperidine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • haloperidol

              meperidine and haloperidol both increase sedation. Use Caution/Monitor.

              meperidine, haloperidol. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • hydromorphone

              hydromorphone and meperidine both increase sedation. Use Caution/Monitor.

            • hydroxyzine

              hydroxyzine and meperidine both increase sedation. Use Caution/Monitor.

            • iloperidone

              meperidine and iloperidone both increase sedation. Use Caution/Monitor.

              meperidine, iloperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • imipramine

              meperidine and imipramine both increase sedation. Use Caution/Monitor.

            • indinavir

              indinavir increases levels of meperidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

            • isoniazid

              isoniazid and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • isoproterenol

              meperidine increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ketamine

              ketamine and meperidine both increase sedation. Use Caution/Monitor.

            • ketotifen, ophthalmic

              meperidine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

            • L-tryptophan

              L-tryptophan and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • lasmiditan

              lasmiditan, meperidine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

            • lemborexant

              lemborexant, meperidine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

            • levalbuterol

              meperidine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • levorphanol

              levorphanol and meperidine both increase sedation. Use Caution/Monitor.

            • lisdexamfetamine

              meperidine increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lithium

              lithium and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • lofepramine

              meperidine and lofepramine both increase sedation. Use Caution/Monitor.

            • lofexidine

              meperidine and lofexidine both increase sedation. Use Caution/Monitor.

            • lopinavir

              lopinavir increases levels of meperidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity.

            • loprazolam

              loprazolam and meperidine both increase sedation. Use Caution/Monitor.

            • lorazepam

              lorazepam and meperidine both increase sedation. Use Caution/Monitor.

            • lormetazepam

              lormetazepam and meperidine both increase sedation. Use Caution/Monitor.

            • loxapine

              meperidine and loxapine both increase sedation. Use Caution/Monitor.

              meperidine, loxapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • loxapine inhaled

              meperidine and loxapine inhaled both increase sedation. Use Caution/Monitor.

              meperidine, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • lsd

              lsd and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • lurasidone

              lurasidone, meperidine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

              meperidine, lurasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • maprotiline

              meperidine and maprotiline both increase sedation. Use Caution/Monitor.

            • marijuana

              meperidine and marijuana both increase sedation. Use Caution/Monitor.

            • melatonin

              meperidine and melatonin both increase sedation. Use Caution/Monitor.

            • meprobamate

              meperidine and meprobamate both increase sedation. Use Caution/Monitor.

            • metaproterenol

              meperidine increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • metaxalone

              metaxalone and meperidine both increase sedation. Use Caution/Monitor.

            • methadone

              meperidine and methadone both increase sedation. Use Caution/Monitor.

            • methamphetamine

              meperidine increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • methocarbamol

              methocarbamol and meperidine both increase sedation. Use Caution/Monitor.

            • methylenedioxymethamphetamine

              meperidine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • midazolam

              midazolam and meperidine both increase sedation. Use Caution/Monitor.

            • midazolam intranasal

              midazolam intranasal, meperidine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of benzodiazepines and opioids increases risk of respiratory depression. Use only in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required.

            • midodrine

              meperidine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • mirtazapine

              meperidine and mirtazapine both increase sedation. Use Caution/Monitor.

              meperidine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • modafinil

              meperidine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • molindone

              meperidine, molindone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • morphine

              meperidine and morphine both increase sedation. Use Caution/Monitor.

              meperidine and morphine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • motherwort

              meperidine and motherwort both increase sedation. Use Caution/Monitor.

            • moxonidine

              meperidine and moxonidine both increase sedation. Use Caution/Monitor.

            • nabilone

              meperidine and nabilone both increase sedation. Use Caution/Monitor.

            • nalbuphine

              meperidine and nalbuphine both increase sedation. Use Caution/Monitor.

            • naratriptan

              naratriptan and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • nelfinavir

              nelfinavir increases levels of meperidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

            • nevirapine

              nevirapine will decrease the level or effect of meperidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased toxic metabolite formation.

            • norepinephrine

              meperidine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nortriptyline

              meperidine and nortriptyline both increase sedation. Use Caution/Monitor.

            • olanzapine

              meperidine and olanzapine both increase sedation. Use Caution/Monitor.

              meperidine, olanzapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • oliceridine

              oliceridine, meperidine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • opium tincture

              meperidine and opium tincture both increase sedation. Use Caution/Monitor.

            • orphenadrine

              orphenadrine and meperidine both increase sedation. Use Caution/Monitor.

            • oxazepam

              oxazepam and meperidine both increase sedation. Use Caution/Monitor.

            • oxycodone

              meperidine and oxycodone both increase sedation. Use Caution/Monitor.

            • oxymorphone

              meperidine and oxymorphone both increase sedation. Use Caution/Monitor.

            • paliperidone

              meperidine and paliperidone both increase sedation. Use Caution/Monitor.

              meperidine, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • papaveretum

              meperidine and papaveretum both increase sedation. Use Caution/Monitor.

            • papaverine

              meperidine and papaverine both increase sedation. Use Caution/Monitor.

            • pegvisomant

              meperidine decreases effects of pegvisomant by unknown mechanism. Use Caution/Monitor.

            • pentazocine

              meperidine and pentazocine both increase sedation. Use Caution/Monitor.

              meperidine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • pentobarbital

              pentobarbital and meperidine both increase sedation. Use Caution/Monitor.

            • perampanel

              perampanel and meperidine both decrease sedation. Use Caution/Monitor.

            • perphenazine

              meperidine and perphenazine both increase sedation. Use Caution/Monitor.

              meperidine, perphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • phendimetrazine

              meperidine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenobarbital

              phenobarbital and meperidine both increase sedation. Use Caution/Monitor.

            • phentermine

              meperidine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenylephrine

              meperidine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenylephrine PO

              meperidine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • pholcodine

              meperidine and pholcodine both increase sedation. Use Caution/Monitor.

            • pimavanserin

              meperidine, pimavanserin. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • pimozide

              meperidine and pimozide both increase sedation. Use Caution/Monitor.

              meperidine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • pirbuterol

              meperidine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pregabalin

              pregabalin, meperidine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • primidone

              primidone and meperidine both increase sedation. Use Caution/Monitor.

            • prochlorperazine

              meperidine and prochlorperazine both increase sedation. Use Caution/Monitor.

            • promethazine

              promethazine and meperidine both increase sedation. Use Caution/Monitor.

            • propofol

              propofol and meperidine both increase sedation. Use Caution/Monitor.

            • propylhexedrine

              meperidine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • protriptyline

              meperidine and protriptyline both increase sedation. Use Caution/Monitor.

            • quazepam

              quazepam and meperidine both increase sedation. Use Caution/Monitor.

            • quetiapine

              meperidine and quetiapine both increase sedation. Use Caution/Monitor.

              meperidine, quetiapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • ramelteon

              meperidine and ramelteon both increase sedation. Use Caution/Monitor.

            • remimazolam

              remimazolam, meperidine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. aCoadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

            • risperidone

              meperidine and risperidone both increase sedation. Use Caution/Monitor.

              meperidine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • ritonavir

              ritonavir increases levels of meperidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity.

            • rizatriptan

              rizatriptan and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • salmeterol

              meperidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • SAMe

              meperidine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.

            • scullcap

              meperidine and scullcap both increase sedation. Use Caution/Monitor.

            • secobarbital

              secobarbital and meperidine both increase sedation. Use Caution/Monitor.

            • sevoflurane

              sevoflurane and meperidine both increase sedation. Use Caution/Monitor.

            • shepherd's purse

              meperidine and shepherd's purse both increase sedation. Use Caution/Monitor.

            • stiripentol

              stiripentol, meperidine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

            • sufentanil

              meperidine and sufentanil both increase sedation. Use Caution/Monitor.

            • sumatriptan

              sumatriptan and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • sumatriptan intranasal

              sumatriptan intranasal and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • suvorexant

              suvorexant and meperidine both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

            • tapentadol

              meperidine and tapentadol both increase sedation. Use Caution/Monitor.

              meperidine and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.

            • temazepam

              temazepam and meperidine both increase sedation. Use Caution/Monitor.

            • terbutaline

              meperidine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • thioridazine

              meperidine and thioridazine both increase sedation. Use Caution/Monitor.

            • thiothixene

              meperidine and thiothixene both increase sedation. Use Caution/Monitor.

              meperidine, thiothixene. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • topiramate

              meperidine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

            • tramadol

              meperidine and tramadol both increase sedation. Use Caution/Monitor.

              meperidine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

            • trazodone

              meperidine and trazodone both increase sedation. Use Caution/Monitor.

            • triazolam

              triazolam and meperidine both increase sedation. Use Caution/Monitor.

            • triclofos

              triclofos and meperidine both increase sedation. Use Caution/Monitor.

            • trifluoperazine

              meperidine and trifluoperazine both increase sedation. Use Caution/Monitor.

              meperidine, trifluoperazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • trimipramine

              meperidine and trimipramine both increase sedation. Use Caution/Monitor.

            • triprolidine

              triprolidine and meperidine both increase sedation. Use Caution/Monitor.

            • xylometazoline

              meperidine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • yohimbine

              meperidine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ziconotide

              meperidine and ziconotide both increase sedation. Use Caution/Monitor.

            • ziprasidone

              meperidine and ziprasidone both increase sedation. Use Caution/Monitor.

              meperidine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • zolmitriptan

              zolmitriptan and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • zotepine

              meperidine and zotepine both increase sedation. Use Caution/Monitor.

            Minor (12)

            • brimonidine

              brimonidine increases effects of meperidine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • bupropion

              meperidine increases toxicity of bupropion by unspecified interaction mechanism. Minor/Significance Unknown. May lower seizure threshold; keep bupropion dose as low as possible.

            • dextroamphetamine

              dextroamphetamine increases effects of meperidine by unspecified interaction mechanism. Minor/Significance Unknown.

            • ethotoin

              ethotoin decreases levels of meperidine by increasing metabolism. Minor/Significance Unknown.

            • eucalyptus

              meperidine and eucalyptus both increase sedation. Minor/Significance Unknown.

            • fosphenytoin

              fosphenytoin decreases levels of meperidine by increasing metabolism. Minor/Significance Unknown.

            • lidocaine

              lidocaine increases toxicity of meperidine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.

            • metoclopramide

              metoclopramide increases effects of meperidine by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Increased CNS depression.

              metoclopramide increases effects of meperidine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • phenytoin

              phenytoin decreases levels of meperidine by increasing metabolism. Minor/Significance Unknown.

            • ritonavir

              ritonavir decreases levels of meperidine by increasing metabolism. Minor/Significance Unknown. Ritonavir induces the metabolism of meperidine to normeperidine, increasing CNS toxicity.

            • sage

              meperidine and sage both increase sedation. Minor/Significance Unknown.

            • ziconotide

              ziconotide, meperidine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.

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            Adverse Effects

            Frequency Not Defined

            To report suspected adverse reactions, contact Validus Pharmaceuticals LLC at 1- 866-982-5438 (1-866-9VALIDUS) or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch

            Agitation

            Angina

            Bradycardia

            Cardiac arrest

            Coma

            Constipation

            Dizziness

            Dry mouth

            Dysphoria

            Euphoria

            Faintness

            Hypotension

            Mental clouding or depression

            Myocardial infarction

            Nausea

            Nervousness

            Palpitation

            Physical and psychological dependence

            Pruritus, urticaria

            QT-interval prolongation

            Respiratory arrest

            Respiratory/circulatory depression

            Restlessness

            Sedation

            Seizures

            Severe cardiac arrhythmias

            Shock

            ST-segment elevation

            Sweating, flushing, warmness of face/neck/upper thorax

            Syncope

            Tachycardia

            Urinary retention

            Visual disturbances

            Vomiting

            Weakness

            Postmarketing Reports

            Life-threatening respiratory depression

            Neonatal opioid withdrawal syndrome

            Adrenal insufficiency

            Severe hypotension

            Abdominal pain

            Serotonin syndrome

            Anaphylaxis

            Androgen deficiency

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            Warnings

            Black Box Warnings

            Opioid analgesic risk evaluation and mitigation strategy (REMS)

            • To ensure that benefits of opioid analgesics outweigh risks of addiction, abuse, and misuse, the Food and Drug Administration (FDA) has required a REMS for these products; under requirements of the REMS, drug companies with approved opioid analgesic products must make REMS-compliant education programs available to healthcare providers
            • Healthcare providers are strongly encouraged to:
              • Complete a REMS-compliant education program
              • Counsel patients and/or their caregivers, with every prescription, on safe use, serious risks, storage, and disposal of these products
              • Emphasize to patients and their caregivers the importance of reading the Medication Guide every time it is provided by their pharmacist
              • Consider other tools to improve patient, household, and community safety

            Addiction, abuse, and misuse

            • Risk of opioid addiction, abuse, and misuse, which can lead to overdose and death; assess each patient’s risk prior to prescribing and monitor all patients regularly for the development of these behaviors or conditions

            Life-threatening respiratory depression

            • Serious, life-threatening, or fatal respiratory depression may occur
            • Monitor for respiratory depression, especially during initiation or following a dose increase

            Neonatal opioid withdrawal syndrome

            • Prolonged use during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts
            • If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available

            Interactions with Drugs Affecting Cytochrome P450 Isoenzymes

            • Concomitant use with cytochrome P450 3A4 inhibitors or discontinuation of inducers can result in fatal overdose of meperidine

            Risks From Concomitant Use With Benzodiazepines Or Other CNS Depressants

            • Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death; reserve concomitant prescribing for use in patients for whom alternative treatment options are inadequate; limit dosages and durations to minimum required; follow patients for signs and symptoms of respiratory depression and sedation

            Concomitant Use of Meperidine with Monoamine Oxidase (MAO) Inhibitors

            • Concomitant use of with Monoamine oxidase (MAO) inhibitors can result in coma, severe respiratory depression, cyanosis and hypotension; use with MAO inhibitors is contraindicated

            Accidental ingestion

            • Accidental ingestion especially by children, can result in a fatal overdose

            Risk of Medication Errors

            • Ensure accuracy when prescribing, dispensing, and administering oral solution; dosing errors due to confusion between mg and mL, and other oral solutions of different concentrations can result in accidental overdose and death

            Contraindications

            Hypersensitivity to drug or component of the formulation

            Acute or severe bronchial asthma in an unmonitored setting or in absence of resuscitative equipment

            Significant respiratory depression

            Known or suspected gastrointestinal obstruction, including paralytic ileus

            Within 14 days of taking MAO inhibitors; if linezolid or IV methylene blue (MAOIs) must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity; may resume 24 hr after last linezolid or methylene blue dose, or after 2 weeks of monitoring, whichever comes first

            Cautions

            Therapy exposes users to the risks of addiction, abuse and misuse; because extended-release products deliver opioid over extended period of time, there is a greater risk for overdose and death due to the larger amount of tramadol present; addiction can occur at recommended dosages and if drug is misused or abused; assess each patient’s risk for opioid addiction, abuse or misuse prior to prescribing therapy; risks are increased in patients with personal or family history of substance abuse (including drug or alcohol abuse or addiction) or mental illness (e.g., major depression); patients at risk may be prescribed opioids but use in such patients necessitates intensive counseling about risks and proper use along with intensive monitoring for signs of addiction, abuse and misuse; strategies to reduce these risks include prescribing drug in smallest appropriate quantity and advising patient on proper disposal of unused drug

            Therapy may cause severe hypotension including orthostatic hypotension and syncope in ambulatory patients; there is increased risk in patients whose ability to maintain blood pressure has already been compromised by a reduced blood volume or concurrent administration of certain CNS depressant drugs (e.g., phenothiazines or general anesthetics); monitor patients for signs of hypotension after initiating or titrating dosage; in patients with circulatory shock, therapy may cause vasodilation that can further reduce cardiac output and blood pressure; avoid therapy in patients with circulatory shock

            In patients who may be susceptible to intracranial effects of CO2 retention (e.g., those with evidence of increased intracranial pressure or brain tumors), therapy may reduce respiratory drive, and resultant CO2 retention can further increase intracranial pressure; monitor such patients for signs of sedation and respiratory depression, particularly when initiating therapy; opioids may obscure clinical course in a patient with a head injury; avoid the use in patients with impaired consciousness or coma

            Contraindicated in patients with known or suspected gastrointestinal obstruction, including paralytic ileus; may cause spasm of sphincter of Oddi; opioids may cause increases in serum amylase; monitor patients with biliary tract disease, including acute pancreatitis, for worsening symptoms

            Use in patients with acute or severe bronchial asthma in unmonitored setting or in absence of resuscitative equipment is contraindicated; patients with significant chronic obstructive pulmonary disease or cor pulmonale, and those with a substantially decreased respiratory reserve, hypoxia, hypercapnia, or pre-existing respiratory depression are at increased risk of decreased respiratory drive including apnea, even at recommended dosages

            Caution in acute abdominal conditions (may obscure diagnosis or clinical course of patient), pseudomembranous colitis, toxin-mediated diarrhea

            Narrow therapeutic index in certain patient populations, particularly in combination with CNS-depressant drugs

            Cardiac arrhythmias, drug abuse or dependence, emotional lability, gallbladder disease, head injury, increased intracranial pressure, benign prostatic hyperplasia, hepatic or renal impairment, seizures with epilepsy, urethral stricture, urinary tract surgery

            Use with caution in following conditions: Sickle cell anemia; acute alcoholism; adrenocortical insufficiency (eg, Addison disease); CNS depression or coma; delirium tremens; debilitated patients; kyphoscoliosis associated with respiratory depression; myxedema or hypothyroidism; prostatic hypertrophy or urethral stricture; head trauma; billiary tract impairment; severe impairment of hepatic, pulmonary, or renal function; toxic psychosis

            Warn patients not to drive or operate dangerous machinery unless they are tolerant to therapy and know how they will react to medication

            While serious, life-threatening, or fatal respiratory depression can occur at any time during therapy, the risk is greatest during the initiation of therapy or following a dosage increase; monitor patients closely for respiratory depression, especially within the first 24-72 hours of initiating therapy with and following dosage increases; to reduce risk of respiratory depression, proper dosing and titration are essential; overestimating dosage when converting patients from another opioid product can result in a fatal overdose with the first dose

            Opioids can cause sleep-related breathing disorders including central sleep apnea (CSA) and sleep-related hypoxemia; opioid use increases risk of CSA in a dose-dependent fashion; in patients who present with CSA, consider decreasing opioid dosage using best practices for opioid taper

            Prolonged use during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts

            If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available

            In patients with pheochromocytoma, meperidine has been reported to provoke hypertension

            If necessary, meperidine may be given intravenously, but injection should be given very slowly, preferably as diluted solution; rapid intravenous injection of narcotic analgesics, including meperidine, increases 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 facilities for assisted or controlled respiration are immediately available; when meperidine is given parenterally, especially intravenously, the patient should be lying down

            Chronic use of opioids may cause reduced fertility in females and males of reproductive potential; it is not known whether effects on fertility are reversible

            Avoid use of mixed agonist/antagonist (e.g., pentazocine, nalbuphine, and butorphanol) or partial agonist (e.g., buprenorphine) analgesics in patients who are receiving a full opioid agonist analgesic; mixed agonist/antagonist and partial agonist analgesics may reduce analgesic effect and/or may precipitate withdrawal symptoms; when discontinuing therapy, gradually taper dosage; do not abruptly discontinue therapy

            May cause less smooth muscle spasm and constipation than equipotent doses of morphine

            Cases of adrenal insufficiency reported with opioid use, more often following greater than one month of use; symptoms may include nausea, vomiting, anorexia, fatigue, weakness, dizziness, and low blood pressure; if adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids; wean patient off of opioid to allow adrenal function to recover and continue corticosteroid treatment until adrenal function recovers; other opioids may be tried as some cases reported use of a different opioid without recurrence of adrenal insufficiency

            Chronic high-dose therapy or administration to patients with renal impairment may result in accumulation of active metabolite normeperidine, leading to agitation and seizures

            Nonmeperidine, an active metabolite and CNS stimulant, may accumulate and precipitate anxiety or seizures; preexisting CNS or renal dysfunction, cumulative dose (>600 mg/24hr in adults), or prolonged use (>48 hr) may increase risk; naloxone does not reverse and may worsen neurotoxicity

            Use caution in patients who are morbidly obese

            Dosing errors can result in accidental overdose and death; avoid dosing errors that may result from confusion between mg and mL and confusion with meperidine solutions of different concentrations, when prescribing, dispensing, and administering oral solution; ensure that dose is communicated clearly and dispensed accurately; healthcare providers should recommend a calibrated device that can measure and deliver the prescribed dose accurately, and instruct caregivers not to use household spoons and to use extreme caution in measuring the dosage

            Opioid analgesic risk evaluation and mitigation strategy (REMS)

            • To ensure that benefits of opioid analgesics outweigh risks of addiction, abuse, and misuse, the Food and Drug Administration (FDA) has required a Risk Evaluation and Mitigation Strategy (REMS) for these products
            • Discuss the safe use, serious risks, and proper storage and disposal of opioid analgesics with patients and/or their caregivers every time these medicines are prescribed; use the following link to obtain the Patient Counseling Guide (PCG): www.fda.gov/OpioidAnalgesicREMSPCG
            • Emphasize to patients and their caregivers the importance of reading the Medication Guide that they will receive from their pharmacist every time an opioid analgesic is dispensed to them
            • Consider using other tools to improve patient, household, and community safety, such as patient-prescriber agreements that reinforce patient-prescriber responsibilities
            • To obtain further information on opioid analgesic REMS and for a list of accredited REMS CME/CE, call 1-800-503-0784, or log on to www.opioidanalgesicrems.com; the FDA Blueprint can be found at www.fda.gov/OpioidAnalgesicREMSBlueprint

            Drug interaction overview

            • Concomitant use with a CYP3A4 inhibitor, such as macrolide antibiotics (e.g., erythromycin), azole-antifungal agents (e.g., ketoconazole), and protease inhibitors (e.g., ritonavir), may increase plasma concentrations of meperidine and prolong opioid adverse reactions, which may cause potentially fatal respiratory depression, particularly when an inhibitor is added after a stable dose of meperidine injection is achieved; similarly, discontinuation of a CYP3A4 inducer, such as rifampin, carbamazepine, and phenytoin, in meperidine-injection treated patients may increase meperidine plasma concentrations and prolong opioid adverse reactions; when using meperidine Injection with CYP3A4 inhibitors or discontinuing CYP3A4 inducers in meperidine-Injection treated patients, monitor patients closely at frequent intervals and consider dosage reduction of meperidine injection until stable drug effects are achieved
            • Concomitant use of meperidine injection with CYP3A4 inducers or discontinuation of a CYP3A4 inhibitor could decrease meperidine plasma concentrations, decrease opioid efficacy or, possibly, lead to a withdrawal syndrome in a patient who had developed physical dependence to meperidine; when using meperidine injection with CYP3A4 inducers or discontinuing CYP3A4 inhibitors, monitor patients closely at frequent intervals and consider increasing opioid dosage if needed to maintain adequate analgesia or if symptoms of opioid withdrawal occur
            • Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death; reserve concomitant prescribing for use in patients for whom alternative treatment options are inadequate; limit dosages and durations to minimum required; follow patients for signs and symptoms of respiratory depression and sedation; if concomitant use is warranted, consider prescribing naloxone for emergency treatment of opioid overdose
            • Cases of serotonin syndrome, a potentially life-threatening condition, reported, particularly during concomitant use with serotonergic drugs. Serotonergic drugs include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), triptans, 5-HT3 receptor antagonists, drugs that affect the serotonergic neurotransmitter system (e.g., mirtazapine, trazodone, tramadol), and drugs that impair metabolism of serotonin (including MAO inhibitors, both those intended to treat psychiatric disorders and also others, such as linezolid and intravenous methylene blue); may occur within recommended dosage range; symptoms may include mental status changes (e.g., agitation, hallucinations, coma), autonomic instability (e.g., tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination, rigidity), and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea); onset of symptoms generally occurs within several hours to a few days of concomitant use, but may occur later than that; discontinue therapy if serotonin syndrome is suspected
            • Meperidine is contraindicated in patients who have received MAO inhibitors within the last 14 days; therapeutic doses of meperidine have occasionally precipitated unpredictable, severe, and occasionally fatal reactions in patients who have received such agents within 14 days; intravenous hydrocortisone or prednisolone have been used to treat severe reactions, with the addition of intravenous chlorpromazine in those cases exhibiting hypertension and hyperpyrexia
            • Due to risk of respiratory depression with concomitant use of skeletal muscle relaxants and opioids, consider prescribing naloxone for emergency treatment of opioid overdose

            Patient access to naloxone for emergency treatment of opioid overdose

            • Assess potential need for naloxone; consider prescribing for emergency treatment of opioid overdose
            • Consult on availability and ways to obtain naloxone as permitted by individual state naloxone dispensing and prescribing requirements or guidelines
            • Educate patients regarding the signs and symptoms of respiratory depression and to call 911 or seek immediate emergency medical help in the event of a known or suspected overdose
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            Pregnancy & Lactation

            Pregnancy: Prolonged use of opioid analgesics during pregnancy for medical or nonmedical purposes can result in physical dependence in neonate and neonatal opioid withdrawal syndrome shortly after birth; the onset, duration, and severity of neonatal opioid withdrawal syndrome vary based on specific opioid used, duration of use, timing and amount of last maternal use, and rate of elimination of drug by newborn; observe newborns for symptoms of neonatal opioid withdrawal syndrome and manage accordingly

            Prolonged use of opioid analgesics during pregnancy for medical or nonmedical purposes can result in physical dependence in neonate and neonatal opioid withdrawal syndrome shortly after birth; the onset, duration, and severity of neonatal opioid withdrawal syndrome vary based on specific opioid used, duration of use, timing and amount of last maternal use, and rate of elimination of drug by newborn; observe newborns for symptoms of neonatal opioid withdrawal syndrome and manage accordingly

            Lactation: Meperidine appears in milk of nursing mothers receiving drug; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed infant or from underlying maternal condition

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Narcotic agonist-analgesic of opiate receptors; inhibits ascending pain pathways, thus altering response to pain; produces analgesia, respiratory depression, and sedation

            Absorption

            Bioavailability: 50-60%; hepatic impairment, 80-90%

            Onset: Rapid

            Duration: PO/SC, 2-4 hr

            Peak plasma time: SC, 40-60 min; IM, 30-50 min

            Distribution

            Protein bound: 65-75%

            Metabolism

            Metabolized in liver via hydrolysis, partial conjugation with glucuronic acid, N-demethylation

            Metabolites: Meperidinic acid, normeperidine (active)

            Elimination

            Half-life: 2.5-4 hr (adults); 7-11 hr (liver disease)

            Excretion: Urine (primarily)

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            Administration

            IV Incompatibilities

            Additive: Aminophylline, amobarbital, floxacillin, furosemide, heparin, morphine, phenobarbital, phenytoin, sodium bicarbonate(?)

            Syringe: Heparin, morphine, pentobarbital

            Y-site: Acyclovir(?), allopurinol, amphotericin B cholesteryl sulfate, cefepime, cefoperazone, doxorubicin, furosemide (may be compatible at lower concentrations), idarubicin, imipenem-cilastatin, minocycline, nafcillin(?)

            Not specified: Diazepam

            IV Compatibilities

            Solution: Most common solvents

            Additive: Cefazolin, dobutamine, metoclopramide, ondansetron, scopolamine, triflupromazine, verapamil

            Syringe: Atropine, butorphanol, chlorpromazine, cimetidine, dimenhydrinate, diphenhydramine, droperidol, fentanyl, glycopyrrolate, hydroxyzine, ketamine, metoclopramide, midazolam, ondansetron, papaveretum, pentazocine, pentazocine with perphenazine, perphenazine, prochlorperazine, promazine, promethazine, promethazine with atropine, ranitidine, scopolamine

            Y-site: Amifostine, amikacin, ampicillin, ampicillin-sulbactam, atenolol, aztreonam, bivalirudin, bumetanide, cefamandole, cefazolin, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftizoxime, ceftriaxone, cefuroxime, chloramphenicol, cisatracurium, cladribine, clindamycin, dexamethasone, dexmedetomidine, diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doxycycline, droperidol, erythromycin, etoposide phosphate, famotidine, fenoldopam, filgrastim, fluconazole, fludarabine, gatifloxacin, gemcitabine, gentamicin, granisetron, heparin, 6% hetastarch in lactated electrolyte injection (Hextend), hydrocortisone, insulin, kanamycin, labetalol, lidocaine, linezolid, magnesium sulfate, melphalan, methyldopate, methylprednisolone, metoclopramide, metoprolol, metronidazole, ondansetron, oxacillin, oxytocin, paclitaxel, penicillin G, piperacillin, piperacillin-tazobactam, potassium chloride, propofol, propranolol, ranitidine, remifentanyl, sargramostim, teniposide, thiotepa, ticarcillin, ticarcillin-clavulanate, tobramycin, trimethoprim, vancomycin, verapamil, vinorelbine

            Not specified: Epinephrine

            Oral Solution Administration

            Ensure accuracy when prescribing, dispensing, and administrating oral solution to avoid dosing errors due to confusion between mg and mL with other meperidine hydrochloride oral solutions of different concentrations, which could result in accidental overdose and death; ensure proper dose is communicated and dispensed; when writing prescriptions, include both the total dose in mg and the total dose in volume

            Do not use household teaspoons or tablespoons to measure oral solution, as using a tablespoon instead of a teaspoon could lead to overdosage

            Use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals

            Dilute each dose of oral solution in one-half glass of water because undiluted solution may exert a slight topical anesthetic effect on mucous membranes

            IV/IM Administration

            IM: Inject into large muscle mass; when repeated injection is needed, IM is preferred to SC

            IV injection: Inject 10 mg/mL very slowly; opiate antagonist and facilities for administration of oxygen and control of respiration should be available during and immediately after administration

            Continuous IV infusion: 15-35 mg/hr

            Drug has been injected or infused epidurally

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            meperidine oral
            -
            50 mg/5 mL solution
            meperidine oral
            -
            100 mg tablet
            meperidine oral
            -
            50 mg tablet
            meperidine oral
            -
            100 mg tablet
            meperidine injection
            -
            10 mg/mL solution
            Demerol injection
            -
            100 mg/mL vial
            Demerol injection
            -
            50 mg/mL vial

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Select a drug:
            Patient Education
            meperidine oral

            MEPERIDINE - ORAL

            (me-PER-i-deen)

            COMMON BRAND NAME(S): Demerol

            WARNING: Meperidine has a risk for abuse and addiction, which can lead to overdose and death. Meperidine may also cause severe, possibly fatal, breathing problems. To lower your risk, your doctor should have you take the smallest dose of meperidine that works, and take it for the shortest possible time. See also How to Use section for more information about addiction.The risk for severe breathing problems is higher when you start this medication and after a dose increase, or if you take the wrong dose/strength. Taking this medication with alcohol or other drugs that can cause drowsiness or breathing problems may cause very serious side effects, including death. Also, other medications can affect the removal of meperidine from your body, which may affect how meperidine works. Be sure you know how to take meperidine and what other drugs you should avoid taking with it. See also Drug Interactions section. Get medical help right away if any of these very serious side effects occur: slow/shallow breathing, unusual lightheadedness, severe drowsiness/dizziness, difficulty waking up.Keep this medicine in a safe place to prevent theft, misuse, or abuse. If someone accidentally swallows this drug, get medical help right away.Before using this medication, women of childbearing age should talk with their doctor(s) about the risks and benefits. Tell your doctor if you are pregnant or if you plan to become pregnant. During pregnancy, this medication should be used only when clearly needed. It may slightly increase the risk of birth defects if used during the first two months of pregnancy. Also, using it for a long time or in high doses near the expected delivery date may harm the unborn baby. To lessen the risk, take the smallest effective dose for the shortest possible time. Babies born to mothers who use this drug for a long time may develop severe (possibly fatal) withdrawal symptoms. Tell the doctor right away if you notice any symptoms in your newborn baby such as crying that doesn't stop, slow/shallow breathing, irritability, shaking, vomiting, diarrhea, poor feeding, or difficulty gaining weight.

            USES: Meperidine is used to help relieve moderate to severe pain. It belongs to a class of drugs known as opioid analgesics and is similar to morphine. It works in the brain to change how your body feels and responds to pain.Meperidine should not be used to treat long-term or ongoing pain. It should only be used to treat sudden episodes of moderate to severe pain. See also Precautions section.This drug is not recommended for use in newborns due to an increased risk of serious side effects. Ask the doctor or pharmacist for details.

            HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking meperidine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth as directed by your doctor, usually every 3 to 4 hours as needed. You may take this drug with or without food. If you have nausea, it may help to take this drug with food. Ask your doctor or pharmacist about other ways to decrease nausea (such as lying down for 1 to 2 hours with as little head movement as possible).If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose. Make sure not to confuse the dose of meperidine liquid in milligrams (mg) with the dose in milliliters (mL). Ask your pharmacist or doctor to show you the right way to measure your dose. Mix your dose with one-half glass of water (4 ounces/120 milliliters) and drink right away. Mixing your dose in water before you take it will prevent your mouth from becoming numb.The dosage is based on your medical condition and response to treatment. Do not increase your dose or use this drug more often or for longer than prescribed because your risk of side effects may increase. Properly stop the medication when so directed.Pain medications work best if they are used as the first signs of pain occur. If you wait until the pain has worsened, the medication may not work as well.Suddenly stopping this medication may cause withdrawal, especially if you have used it for a long time or in high doses. To prevent withdrawal, your doctor may lower your dose slowly. Tell your doctor or pharmacist right away if you have any withdrawal symptoms such as restlessness, mental/mood changes (including anxiety, trouble sleeping, thoughts of suicide), watering eyes, runny nose, nausea, diarrhea, sweating, muscle aches, or sudden changes in behavior.When this medication is used for a long time, it may not work as well. Talk with your doctor if this medication stops working well.Though it helps many people, this medication may sometimes cause addiction. This risk may be higher if you have a substance use disorder (such as overuse of or addiction to drugs/alcohol). Take this medication exactly as prescribed to lower the risk of addiction. Ask your doctor or pharmacist for more details.Tell your doctor if your pain does not get better or if it gets worse.

            SIDE EFFECTS: See also Warning section.Nausea, vomiting, constipation, sweating, lightheadedness, dizziness, or drowsiness may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.To prevent constipation, eat dietary fiber, drink enough water, and exercise. You may also need to take a laxative. Ask your pharmacist which type of laxative is right for you.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: interrupted breathing during sleep (sleep apnea), mental/mood changes (such as agitation, confusion, hallucinations), stomach/abdominal pain, difficulty urinating, slow/irregular/fast heartbeat, shaking (tremors), vision changes, signs of your adrenal glands not working well (such as loss of appetite, unusual tiredness, weight loss).Get medical help right away if you have any very serious side effects, including: fainting, seizure, severe drowsiness/difficulty waking up.This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before taking meperidine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before taking this medication, tell your doctor or pharmacist your medical history, especially of: brain disorders (such as head injury, tumor, seizures), breathing problems (such as asthma, sleep apnea, chronic obstructive pulmonary disease-COPD), gallbladder disease, kidney disease, liver disease, mental/mood disorders (such as confusion, depression, thoughts of suicide), personal or family history of a substance use disorder (such as overuse of or addiction to drugs/alcohol), stomach/intestinal problems (such as blockage, constipation, diarrhea due to infection, paralytic ileus), disease of the pancreas (pancreatitis), difficulty urinating (such as due to enlarged prostate), pheochromocytoma, heart problems (such as fast/irregular heartbeat), sickle cell anemia.Meperidine is usually used only for a short time. Repeated or high doses may cause drug levels to build up in the body and cause serious side effects such as seizures and shaking. Caution is advised if this medication is used for conditions that require long-term or high-dosage treatment (such as sickle cell anemia, burns, cancer). Consult your doctor or pharmacist for details.This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this drug, especially confusion, dizziness, drowsiness, and slow/shallow breathing.Children may be more sensitive to the side effects of this drug, especially severe drowsiness and slow/shallow breathing.During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. Discuss the risks and benefits with your doctor. (See also Warning section.)This drug passes into breast milk and may have undesirable effects on a nursing infant. Tell the doctor right away if your baby develops unusual sleepiness, difficulty feeding, or trouble breathing. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: See also Warning section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: certain pain medications (mixed opioid agonist-antagonists such as butorphanol, nalbuphine, pentazocine), naltrexone, samidorphan.Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication.The risk of serious side effects (such as slow/shallow breathing, severe drowsiness/dizziness) may be increased if this medication is used with other products that may also cause drowsiness or breathing problems. Tell your doctor or pharmacist if you are taking other products such as other opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.Other medications can affect the removal of meperidine from your body, which may affect how meperidine works. Examples include azole antifungals (such as ketoconazole), macrolide antibiotics (such as erythromycin), mifepristone, rifamycins (such as rifabutin), ritonavir, drugs used to treat seizures (such as carbamazepine, phenytoin), among others.This medication may interfere with certain laboratory tests (including amylase/lipase tests), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, give them naloxone if available, then call 911. If the person is awake and has no symptoms, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: slow/shallow breathing, severe drowsiness, coma.

            NOTES: Do not share this medication with others. Sharing it is against the law.This medication has been prescribed for your current condition only. Do not use it later for another condition unless your doctor directs you to do so. A different medication may be necessary in that case.Ask your doctor or pharmacist if you should have naloxone available to treat opioid overdose. Teach your family or household members about the signs of an opioid overdose and how to treat it.

            MISSED DOSE: Not applicable.

            STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. For more details, read the Medication Guide, or consult your pharmacist or local waste disposal company.

            Information last revised October 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Additional Offers
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.