Dosing & Uses
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (12)
- 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.
- nirmatrelvir
nirmatrelvir will increase the level or effect of meperidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Nirmatrelvir/ritonavir is contraindicated with drugs that are highly dependent on CYP3A for clearance and for which elevated concentrations are associated with serious and/or life-threatening reactions.
- nirmatrelvir/ritonavir
nirmatrelvir/ritonavir will increase the level or effect of meperidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Nirmatrelvir/ritonavir is contraindicated with drugs that are highly dependent on CYP3A for clearance and for which elevated concentrations are associated with serious and/or life-threatening reactions.
- 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 (60)
- 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.
- olopatadine intranasal
meperidine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- 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 (238)
- 5-HTP
5-HTP and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.
- acrivastine
acrivastine and meperidine both increase sedation. Use Caution/Monitor.
- 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.
- amisulpride
amisulpride and meperidine both increase sedation. Use Caution/Monitor.
- 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).
asenapine and meperidine both increase sedation. Use Caution/Monitor. - asenapine transdermal
asenapine transdermal and meperidine both increase sedation. Use Caution/Monitor.
- atazanavir
atazanavir increases levels of meperidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .
- avapritinib
avapritinib and meperidine both increase sedation. Use Caution/Monitor.
- 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.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen and meperidine 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.
- brexpiprazole
brexpiprazole and meperidine both increase sedation. Use Caution/Monitor.
- brimonidine
brimonidine and meperidine both increase sedation. Use Caution/Monitor.
- brivaracetam
brivaracetam and meperidine both increase 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 subdermal implant
buprenorphine subdermal implant and meperidine both increase sedation. Use Caution/Monitor.
- buprenorphine transdermal
buprenorphine transdermal 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.
buprenorphine, long-acting injection and meperidine both increase sedation. Use Caution/Monitor. - 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 topical
cocaine topical 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.
- daridorexant
meperidine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- 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. - dextroamphetamine transdermal
meperidine, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).
- 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.
- difelikefalin
difelikefalin and meperidine both increase sedation. 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. - fentanyl
fentanyl and meperidine both increase sedation. Use Caution/Monitor.
- fentanyl intranasal
fentanyl intranasal and meperidine both increase sedation. Use Caution/Monitor.
- fentanyl iontophoretic transdermal system
fentanyl iontophoretic transdermal system and meperidine both increase sedation. Use Caution/Monitor.
- fentanyl transdermal
fentanyl transdermal and meperidine both increase sedation. Use Caution/Monitor.
- 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.
- ganaxolone
meperidine and ganaxolone both increase sedation. Use Caution/Monitor.
- gepirone
gepirone and meperidine both increase serotonin levels. Use Caution/Monitor. Monitor for symptoms of serotonin syndrome when gepirone is used gepirone with other drugs that may affect the serotonergic neurotransmitter systems. If serotonin syndrome occurs, consider discontinue gepirone and/or concomitant serotonergic drug.
- 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.
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
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
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.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)
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
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| meperidine injection - | 10 mg/mL solution |  | |
| Demerol injection - | 50 mg/mL vial |  | |
| Demerol injection - | 100 mg/mL vial |  | |
| meperidine oral - | 50 mg/5 mL solution |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
meperidine injection
MEPERIDINE - INJECTION
(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 use the smallest dose of meperidine that works, and use it for the shortest possible time. See also How to Use section for more information about addiction.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.The risk for severe breathing problems is higher when you start this medication and after a dose increase, or if you use the wrong dose/strength. Using 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 use meperidine and what other drugs you should avoid using 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 may also be used before and during surgery or other procedures. Meperidine 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: This medication is given by injection into a vein, into a muscle, or under the skin as directed by your doctor.If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.When meperidine is injected into a vein, it is given very slowly to prevent serious side effects. If this medication is given into a muscle or under the skin, it is important to change the injection site each time to lessen injury under the skin. You should be lying down when the injection is given to prevent side effects such as dizziness.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.If you have nausea, ask your doctor or pharmacist for ways to decrease it (such as lying down with as little head movement as possible).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). Use 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, drowsiness, or pain/redness at the injection site may occur. If any of these effects last or get worse, 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 using 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 using 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 lab tests (such as amylase/lipase tests), possibly causing false test results. Make sure lab 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.
MISSED DOSE: Not applicable.
STORAGE: Different products have different storage needs. Check the product package for instructions on how to store your brand, or ask your pharmacist. 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. Consult your pharmacist or local waste disposal company.
Information last revised July 2023. Copyright(c) 2023 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.
Formulary
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- 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.
