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Technical details about Pethidine hydrochloride, learn more about the structure, uses, toxicity, action, side effects and more

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2D Structure
Also known as: Antiduol, Centralgin, Dispadol, Dolantal, Dolantin, Dolargan
Molecular Formula
C15H22ClNO2
Molecular Weight
283.79368  g/mol
InChI Key
WCNLCIJMFAJCPX-UHFFFAOYSA-N
FDA UNII
N8E7F7Q170

A narcotic analgesic that can be used for the relief of most types of moderate to severe pain, including postoperative pain and the pain of labor. Prolonged use may lead to dependence of the morphine type; withdrawal symptoms appear more rapidly than with morphine and are of shorter duration.
1 2D Structure

2D Structure

2 Identification
2.1 Computed Descriptors
2.1.1 IUPAC Name
ethyl 1-methyl-4-phenylpiperidine-4-carboxylate;hydrochloride
2.1.2 InChI
InChI=1S/C15H21NO2.ClH/c1-3-18-14(17)15(9-11-16(2)12-10-15)13-7-5-4-6-8-13;/h4-8H,3,9-12H2,1-2H3;1H
2.1.3 InChI Key
WCNLCIJMFAJCPX-UHFFFAOYSA-N
2.1.4 Canonical SMILES
CCOC(=O)C1(CCN(CC1)C)C2=CC=CC=C2.Cl
2.2 Other Identifiers
2.2.1 UNII
N8E7F7Q170
2.3 Synonyms
2.3.1 MeSH Synonyms

1. Demerol

2. Dolantin

3. Dolargan

4. Dolcontral

5. Dolin

6. Dolosal

7. Dolsin

8. Isonipecain

9. Lidol

10. Lydol

11. Meperidine

12. Meperidine Hydrochloride

13. Operidine Epj I

14. Operidine Epj-i

15. Pethidine

2.3.2 Depositor-Supplied Synonyms

1. Antiduol

2. Centralgin

3. Dispadol

4. Dolantal

5. Dolantin

6. Dolargan

7. Dolestine

8. Dolaren

9. Algil

10. Dolin

11. Lidol

12. Pethidine Hydrochloride

13. Dolcontral

14. Meperidine Hydrochloride

15. Dolosal

16. Demerol Hydrochloride

17. Doloneurine

18. Synelaudine

19. Antidurol

20. Dolenal

21. Dolenol

22. Mefedina

23. Mepadin

24. Mialgin

25. Operidine

26. Petantin

27. Petidin

28. Piridosal

29. Meperidine Hcl

30. Alodan (gerot)

31. Pethidine Chloride

32. Petantin Hydrochloride

33. Dolopethin

34. Pantalgine

35. Sauteralgyl

36. Spasmodolin

37. Endolat

38. Mephedine

39. Spasmedal

40. Isonipecaine Hydrochloride

41. Chlorbicyclene [french]

42. Wy 554

43. (+-)-pethidine Hydrochloride

44. Unii-n8e7f7q170

45. 50-13-5

46. S 140

47. Ethyl 1-methyl-4-phenylpiperidine-4-carboxylate Hydrochloride

48. Ethyl-1-methyl-4-phenylisonipecotate Hydrochloride

49. Einecs 200-013-3

50. Nih 10522

51. 1-methyl-4-carbethoxy-4-phenylpiperidine Hydrochloride

52. N-methyl-4-phenyl-4-carbethoxypiperidine Hydrochloride

53. Nsc 400479

54. 1-methyl-4-phenyl-4-carboethoxypiperidine Hydrochloride

55. 1-methyl-4-phenylisonipecotic Acid Ethyl Ester Hydrochloride

56. Ethyl 1-methyl-4-phenylpiperidyl-4-carboxylate Hydrochloride

57. 4-piperidinecarboxylic Acid, 1-methyl-4-phenyl-, Ethyl Ester, Hydrochloride

58. Ethyl 1-methyl-4-phenylisonipecotate Hydrochloride

59. Meperidine Hydrochloride (usp)

60. Meperidine Hydrochloride [usp]

61. Ethyl 1-methyl-4-phenylpiperidine-4-carboxylate,hydrochloride

62. Isonipecotic Acid, 1-methyl-4-phenyl-, Ethyl Ester, Hydrochloride

63. 1-methyl-4-phenylpiperidine-4-carboxylic Acid Ethyl Ester Hydrochloride

64. 2793-00-2

65. Dolantol

66. Meperitab

67. Pethidine Hcl

68. Demerol (tn)

69. Ethyl 1-methyl-4-phenylpiperidine-4-carboxylate;hydrochloride

70. Dolantin Hydrochloride

71. Pethidine, Hydrochloride

72. Surecn41046

73. Ac1l1l1z

74. Agn-pc-0jk7d1

75. Chembl1701

76. 57-42-1 (parent)

77. M3142_sigma

78. Pethidine Hydrochloride [jan]

79. Ac1q64p9

80. (+/-)-pethidine Hydrochloride

81. Pethidine Hydrochloride (jp16)

82. N8e7f7q170

83. Ar-1j2693

84. Meperidine Hydrochloride [usan:usp]

85. Nsc400479

86. Wln: T6ntj A1 Dvo2 Dr &gh

87. Meperidine Hcl Preservative Free

88. Nsc-400479

89. Ls-85123

90. Meperidine Hydrochloride Preservative Free

91. Ls-114739

92. Ft-0603214

93. Isonipecotic Acid, Ethyl Ester, Hydrochloride

94. D01383

95. Piperidine, N-methyl-4-phenyl-4-carbethoxy-, Hydrochloride

96. 1-methyl-4-phenyl-isonipecotic Acid Ethyl Ester Hydrochloride

97. Ethyl 1-methyl-4-phenylpiperidine-4-carboxylate Hydrochloride (1:1)

98. 1-methyl-4-phenyl-4-piperidinecarboxylic Acid Ethyl Ester Hydrochloride

99. Dolvanolendolatethyl 1-methyl-4-phenylpiperidine-4-carboxylate Hydrochloride

100. (+-)-1-methyl-4-phenyl-4-piperidinecarboxylic Acid Ethyl Ester Hydrochloride

101. 4-piperidinecarboxylic Acid, 1-methyl-4-phenyl-, Ethyl Ester, Hydrochloride, (+-)-

2.3.3 Other Synonyms

1. Meperidine Hydrochloride

2.4 Create Date
2005-03-27
3 Chemical and Physical Properties
Molecular Weight 283.79368 g/mol
Molecular Formula C15H22ClNO2
Hydrogen Bond Donor Count1
Hydrogen Bond Acceptor Count3
Rotatable Bond Count4
Exact Mass283.133907 g/mol
Monoisotopic Mass283.133907 g/mol
Topological Polar Surface Area29.5 A^2
Heavy Atom Count19
Formal Charge0
Complexity276
Isotope Atom Count0
Defined Atom Stereocenter Count0
Undefined Atom Stereocenter Count0
Defined Bond Stereocenter Count0
Undefined Bond Stereocenter Count0
Covalently Bonded Unit Count2
4 Drug and Medication Information
4.1 Drug Information
1 of 4  
Drug NameMeperidine hydrochloride
Drug LabelMeperidine hydrochloride is a white crystalline substance with a melting point of 186 C to 189 C. It is readily soluble in water and has a neutral reaction and a slightly bitter taste. The solution is not decomposed by a short period of boiling.T...
Active IngredientMeperidine hydrochloride
Dosage FormTablet; Syrup; Injectable
RouteInjection; Oral
Strength75mg/ml; 150mg; 50mg/5ml; 75mg; 50mg/ml; 25mg/ml; 100mg; 100mg/ml; 50mg
Market StatusPrescription
CompanyVintage Pharms; Epic Pharma; Sun Pharm Inds; Mallinckrodt; Roxane; Hikma Maple; Mikart; Barr

2 of 4  
Drug NameMeperidine hydrochloride preservative free
Active IngredientMeperidine hydrochloride
Dosage FormInjectable
RouteInjection
Strength10mg/ml
Market StatusPrescription
CompanyHospira; Hikma Maple

3 of 4  
Drug NameMeperidine hydrochloride
Drug LabelMeperidine hydrochloride is a white crystalline substance with a melting point of 186 C to 189 C. It is readily soluble in water and has a neutral reaction and a slightly bitter taste. The solution is not decomposed by a short period of boiling.T...
Active IngredientMeperidine hydrochloride
Dosage FormTablet; Syrup; Injectable
RouteInjection; Oral
Strength75mg/ml; 150mg; 50mg/5ml; 75mg; 50mg/ml; 25mg/ml; 100mg; 100mg/ml; 50mg
Market StatusPrescription
CompanyVintage Pharms; Epic Pharma; Sun Pharm Inds; Mallinckrodt; Roxane; Hikma Maple; Mikart; Barr

4 of 4  
Drug NameMeperidine hydrochloride preservative free
Active IngredientMeperidine hydrochloride
Dosage FormInjectable
RouteInjection
Strength10mg/ml
Market StatusPrescription
CompanyHospira; Hikma Maple

4.2 Therapeutic Uses

Adjuvants, Anesthesia; Analgesics, Opioid; Narcotics

National Library of Medicine's Medical Subject Headings online file (MeSH, 1999)


Parenteral dosage forms of most opioid analgesics are indicated to provide analgesic, antianxiety, and sedative effects as presurgical medication. However, other medications, such as benzodiazepine, are more commonly used if the patient is not in pain. /Opioid (narcotic) analgesics; Included in US product labeling/

USP. Convention. USPDI - Drug Information for the Health Care Professional. 19th ed. Volume I.Micromedex, Inc. Englewood, CO., 1999. Content Prepared by the U.S. Pharmacopieal Convention, Inc., p. 2169


Epidural or intrathecal administration of small doses of opioid analgesics may provide prolonged pain relief. Although administration via these routes may decrease the risk of some side/adverse effects, respiratory depression may occur. Solutions containing a preservative must not be used. Only morphine sulfate is currently commercially available in a dosage form that is FDA approved for administration via these routes. /Opioid (narcotic) analgesics; Included in US product labeling/

USP. Convention. USPDI - Drug Information for the Health Care Professional. 19th ed. Volume I.Micromedex, Inc. Englewood, CO., 1999. Content Prepared by the U.S. Pharmacopieal Convention, Inc., p. 2169


... Other opioid analgesics are indicated for relief of moderate to severe pain. /Opioid (narcotic) analgesics; Included in US product labeling/

USP. Convention. USPDI - Drug Information for the Health Care Professional. 19th ed. Volume I.Micromedex, Inc. Englewood, CO., 1999. Content Prepared by the U.S. Pharmacopieal Convention, Inc., p. 2169


JUDICIOUSLY USED, NARCOTIC ANALGESICS SUCH AS MEPERIDINE CAN BE OF GREAT VALUE IN ALLAYING APPREHENSION & SOMETIMES IN ABORTING PROGRESSION OF ASTHMATIC ATTACK TO STATUS ASTHMATICUS.

Goodman, L.S., and A. Gilman. (eds.) The Pharmacological Basis of Therapeutics. 5th ed. New York: Macmillan Publishing Co., Inc., 1975., p. 267


MEDICATION (VET): The analgesic effect of meperidine is intermediate between codeine and morphine. In dogs, meperidine (4.4 mg/kg) administered intramuscularly every 3-6 hr has been used to depress the cough reflex and in treatment of cardiac "asthma." In the horse, meperidine produces analgesia within a few min following iv admin and 15-25 min after an im injection.

Booth, N.H., L.E. McDonald (eds.). Veterinary Pharmacology and Therapeutics. 5th ed. Ames, Iowa: Iowa State University Press, 1982., p. 286


MEDICATION (VET): Meperidine will relax the intestine, bronchi, ureter, and, to some degree, uterus. Meperidine, morphine, and methadone depress intestinal peristalsis in the dog.

Booth, N.H., L.E. McDonald (eds.). Veterinary Pharmacology and Therapeutics. 5th ed. Ames, Iowa: Iowa State University Press, 1982., p. 286


MEDICATION (VET): It is used to allay parturition pains because it does not appreciably depress fetal respiration.

Booth, N.H., L.E. McDonald (eds.). Veterinary Pharmacology and Therapeutics. 5th ed. Ames, Iowa: Iowa State University Press, 1982., p. 286


MEDICATION (VET): In dogs and cats, meperidine given preanesthetically eliminates the period of excitement and reduces the amount of anesthetic needed. There is individual variation in the depressant effects of meperidine.

Booth, N.H., L.E. McDonald (eds.). Veterinary Pharmacology and Therapeutics. 5th ed. Ames, Iowa: Iowa State University Press, 1982., p. 287


MEDICATION (VET): In the dog, meperidine is used intramuscularly for preanesthetic medication ... Duration of analgesia induced by meperidine is approximately 45 minutes.

Booth, N.H., L.E. McDonald (eds.). Veterinary Pharmacology and Therapeutics. 5th ed. Ames, Iowa: Iowa State University Press, 1982., p. 287


MEDICATION (VET): Meperidine ... administered subcutaneously in large sows and boars contributes little towards restraint. For preanesthetic medication on the pig, meperidine, ... promazine hydrochloride, ... and atropine ... work satisfactorily prior to barbiturate and inhalant anesthesia. All these preanesthetic preparations are administered intramuscularly in separate sites 45-60 minutes prior to induction of anesthesia.

Booth, N.H., L.E. McDonald (eds.). Veterinary Pharmacology and Therapeutics. 5th ed. Ames, Iowa: Iowa State University Press, 1982., p. 287


MEDICATION (VET): Total iv and im doses of meperidine recommended for the adult horse are 500 and 1000 mg respectively. In cattle an im dose of 500 mg is recommended. Meperidine is used with acepromazine in the mare to relieve pain and discomfort following cesarean section. It has also been used to treat equine colic, especially acute spasmodic conditions. However, meperidine ... administered intramuscularly produces only an inconsistent and transient analgesia in the horse following experimentally induced colic; xylazine is a superior analgesic compared to meperidine, pentazocine, and dipyrone for treatment of induced colic.

Booth, N.H., L.E. McDonald (eds.). Veterinary Pharmacology and Therapeutics. 5th ed. Ames, Iowa: Iowa State University Press, 1982., p. 287


MEDICATION (VET): In cattle, the drug is used for calving to calm the nervous heifer and provide analgesia during parturition. Meperidine does not inhibit uterine contractions in cattle.

Booth, N.H., L.E. McDonald (eds.). Veterinary Pharmacology and Therapeutics. 5th ed. Ames, Iowa: Iowa State University Press, 1982., p. 287


This analgesic is widely used in ... obstetric analgesia. Meperidine is preferred to morphine for obstetric use because its rapid onset of action and shorter duration usually permit greater flexibility in maternal analgesia, possibly with less effect on neonatal respiration. /Meperidine hydrochloride/

American Medical Association. AMA Drug Evaluations Annual 1991. Chicago, IL: American Medical Association, 1991., p. 93


Meperidine is a strong analgesic used in the relief of moderate to severe pain. The drug has been used to relieve the pain of myocardial infarction, although it is probably not as effective as morphine sulfate. Meperidine is also used parenterally for preoperative sedation, as a supplement to anesthesia ... Meperidine is used in patients with acute pulmonary edema for its cardiovascular effects and to allay anxiety. The drug should not be used in the treatment of pulmonary edema resulting from a chemical respiratory irritant.

McEvoy, G.K. (ed.). American Hospital Formulary Service-Drug Information 19 98. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 1998 (Plus Supplements)., p. 1687


Preservative free meperidine ... injected epidurally relieves pain in cancer patients within 5 minutes after administration.

Booth, N.H., L.E. McDonald (eds.). Veterinary Pharmacology and Therapeutics. 5th ed. Ames, Iowa: Iowa State University Press, 1982., p. 381


Meperidine hydrochloride is administered orally, by subcutaneous, im, or slow iv injection; or by slow, continuous iv infusion. The drug is least effective when given orally. Each dose of the oral solution should be taken in one half glassful of water, since the undiluted solution may produce slight topical anesthesia on mucous membranes. When repeat doses are necessary, the im route is preferred over subcutaneous administration because of occurrence of local tissue irritation and induration following subcutaneous injection. If iv administration is required, meperidine dosage should be decreased and the commercially available injections should be administered very slowly, preferably as dilute solutions. Alternatively, the commercially available injection containing 10 mg/ml, which should be used only with a compatible infusion device and does not require further dilution, may be used; the 10 mg/ml injection is intended for single use only, and unused portions should be appropriately discarded. When meperidine is given parenterally, especially by the iv route, the patient should be lying down. An opiate antagonist and facilities for administration of oxygen and control of respiration should be available during and immediately following iv administration of the drug. /Meperidine hydrochloride/

McEvoy, G.K. (ed.). American Hospital Formulary Service-Drug Information 19 98. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 1998 (Plus Supplements)., p. 1687


Meperidine hydrochloride should be given in the smallest effective dose and as frequently as possible to minimize the development of tolerance and physical dependence. Reduced dosage is indicated in poor risk patients, in very young or very old patients, and in patients receiving other CNS depressants. ... As a supplement to anesthesia, meperidine may be given by repeated slow iv injections of a dilute solution ... or by continuous iv infusion of a more dilute solution ... /Meperidine hydrochloride/

McEvoy, G.K. (ed.). American Hospital Formulary Service-Drug Information 19 98. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 1998 (Plus Supplements)., p. 1687


Meperidine can be used in any situation where an opioid analgesic is required. However, in a number of clinical conditions, its lesser spasmogenic effects or its better oral efficacy make meperidine preferable to morphine.

Hardman, J.G., L.E. Limbird, P.B. Molinoff, R.W. Ruddon, A.G. Goodman (eds.). Goodman and Gilman's The Pharmacological Basis of Therapeutics. 9th ed. New York, NY: McGraw-Hill, 1996., p. 543


In general, 75 to 100 mg of meperidine hydrochloride given parenterally is approximately equivalent to 10 mg of morphine, and, in equianalgesic doses, meperidine produces as much sedation, respiratory depression, and euphoria as does morphine. In terms of total analgesic effect, meperidine is less than one half as effective when given by mouth as when administered parenterally ...

Hardman, J.G., L.E. Limbird, P.B. Molinoff, R.W. Ruddon, A.G. Goodman (eds.). Goodman and Gilman's The Pharmacological Basis of Therapeutics. 9th ed. New York, NY: McGraw-Hill, 1996., p. 541


Pethidine ... iv relieved hiccup of long duration, or during anesthesia within 2 minutes. ... The initial dose ... might be repeated with 1 hour if the hiccup returned but it should not be repeated a second time for at least 3 hours.

Reynolds, J.E.F., Prasad, A.B. (eds.) Martindale-The Extra Pharmacopoeia. 28th ed. London: The Pharmaceutical Press, 1982., p. 1028


... Meperidine ... by rapid iv infusion reduces amphotericin B-induced rigors ... Administration of an average meperidine dose ... has been found to resolve chills three times faster than placebo.

Young, L.Y., M.A. Koda-Kimble (eds.). Applied Therapeutics. The Clinical Use of Drugs. 6th ed. Vancouver, WA., Applied Therapeutics, Inc. 1995., p. 69-11


THERAP CAT (VET): Analgesic (narcotic); sedative; anesthetic

Budavari, S. (ed.). The Merck Index - An Encyclopedia of Chemicals, Drugs, and Biologicals. Whitehouse Station, NJ: Merck and Co., Inc., 1996., p. 998


4.3 Drug Warning

MEPERIDINE SHOULD BE USED WITH CAUTION & IN REDUCED DOSAGE IN PT ON OTHER NARCOTIC ANALGESICS, GENERAL ANESTHETICS, PHENOTHIAZINES, SEDATIVES, TRICYCLIC ANTIDEPRESSANTS & OTHER CNS DEPRESSANTS. /MEPERIDINE HYDROCHLORIDE/

Osol, A. and J.E. Hoover, et al. (eds.). Remington's Pharmaceutical Sciences. 15th ed. Easton, Pennsylvania: Mack Publishing Co., 1975., p. 1045


MEPERIDINE CANNOT BE CONSIDERED INNOCUOUS DRUG FOR USE IN PT WITH BRONCHIAL ASTHMA, SINCE IT DEPRESSES RESP DRIVE WITHOUT DECR RESP RESISTANCE.

Goodman, L.S., and A. Gilman. (eds.) The Pharmacological Basis of Therapeutics. 5th ed. New York: Macmillan Publishing Co., Inc., 1975., p. 267


Contraindications to use of meperidine are similar to those for morphine & other opioid analgesics. Because changes in drug disposition have been reported in patients with liver disease and the elderly, dosage must be reduced in these individuals.

American Medical Association. AMA Drug Evaluations Annual 1991. Chicago, IL: American Medical Association, 1991., p. 94


ABUSE LEADS TO HABITUATION OR ADDICTION. /MEPERIDINE HYDROCHLORIDE/

The Merck Index. 10th ed. Rahway, New Jersey: Merck Co., Inc., 1983., p. 834


MEPERIDINE ABSTINENCE SYNDROME USUALLY DEVELOPS WITHIN 3 HR AFTER LAST DOSE, REACHES ITS PEAK WITHIN 8-12 HR, & THEN DECLINES, SO THAT FEW SYMPTOMS ARE APPARENT AFTER 4-5 DAYS. CRAVING MAY BE INTENSE, BUT NONPURPOSIVE AUTONOMIC SIGNS, WHILE PRESENT, ARE NOT AS PROMINENT; THE PUPILS MAY NOT BE WIDELY DILATED, & THERE IS USUALLY LITTLE NAUSEA, VOMITING & DIARRHEA. HOWEVER, AT PEAK INTENSITY MUSCLE TWITCHING, RESTLESSNESS, & NERVOUSNESS MAY BE WORSE THAN DURING MORPHINE WITHDRAWAL.

Goodman, L.S., and A. Gilman. (eds.) The Pharmacological Basis of Therapeutics. 5th ed. New York: Macmillan Publishing Co., Inc., 1975., p. 297


Vet: Meperidine is best administered intramuscularly in animals. The sc route is not preferred because local irritation and pain may be produced. Oral administration is not advised in large animals because of the cost. If the drug contacts buccal mucosa, particularly in the cat, considerable irritation and salivation result. IV injection must be made slowly to avoid drug shock and prostration. Following im or sc administration in the cat, emesis does not occur, but defecation occurs in some animals. /Meperidine hydrochloride/

Booth, N.H., L.E. McDonald (eds.). Veterinary Pharmacology and Therapeutics. 5th ed. Ames, Iowa: Iowa State University Press, 1982., p. 285


When meperidine (22 mg/kg) is administered intravenously ... the plasma half-life /was found/ to be 0.7 hr in the cat. Despite the short half-life in plasma, the analgesic effect of 11 mg/kg of the drug given intramuscularly is apparent at 2 hr but not at 0.5 hr or 4 hr after administration. Because duration of effective plasma levels of meperidine is short and the biotransformation is rapid ... /it was/ stated that meperidine probably will serve better as a preanesthetic drug than in management of severe pain in cats.

Booth, N.H., L.E. McDonald (eds.). Veterinary Pharmacology and Therapeutics. 5th ed. Ames, Iowa: Iowa State University Press, 1982., p. 286


Studies in healthy subjects indicated that patients should not drive or operate machinery for 24 hours after receiving pethidine 75 mg intramuscularly.

Reynolds, J.E.F., Prasad, A.B. (eds.) Martindale-The Extra Pharmacopoeia. 28th ed. London: The Pharmaceutical Press, 1982., p. 1026


Since meperidine may increase ventricular response rate through a vagolytic action, the drug should be used with caution in patients with atrial flutter and other supraventricular tachycardias. In one study in patients with myocardial infarction, meperidine hydrochloride in iv doses of 100 mg appeared to cause various circulatory disturbances including increases in mean aortic pressure, systemic vascular resistance, and heart rate. Occasional occurrence of sinus tachycardia in postoperative patients has been attributed to meperidine. /Meperidine hydrochloride/

McEvoy, G.K. (ed.). American Hospital Formulary Service-Drug Information 19 98. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 1998 (Plus Supplements)., p. 1687


Some commercially available formulations of meperidine hydrochloride contain sodium metabisulfite, a sulfite that may cause allergic-type reactions, including anaphylaxis and life-threatening or less severe asthmatic episodes, in certain susceptible individuals. The overall prevalence of sulfite sensitivity in the general population is unknown but probably low; such sensitivity appears to occur more frequently in asthmatic than in nonasthmatic individuals. /Meperidine hydrochloride/

McEvoy, G.K. (ed.). American Hospital Formulary Service-Drug Information 19 98. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 1998 (Plus Supplements)., p. 1687


Since virtually all the reported incidents of opiate agonist interactions with monoamine oxidase (MAO) inhibitors have occurred in patients receiving meperidine, /this drug/ is contraindicated in patients who have received these drugs during the past 14 days. In some patients receiving MAO inhibitors, therapeutic doses of meperidine have produced coma, severe respiratory depression, cyanosis, and hypotension resembling the typical syndrome of acute opiate agonist overdosage. In other patients on MAO inhibitor therapy, meperidine has caused hyperexcitability, seizures, tachycardia, hyperpyrexia, and hypertension. /Meperidine hydrochloride/

McEvoy, G.K. (ed.). American Hospital Formulary Service-Drug Information 19 98. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 1998 (Plus Supplements)., p. 1687


In therapeutic doses, meperidine has no significant untoward effects on the cardiovascular system, particularly when patients are recumbent; myocardial contractility is not depressed, and the ECG is unaltered. Ambulatory patients given meperidine may experience syncope associated with a fall in blood pressure, but symptoms rapidly clear if the recumbent position is assumed. After the intravenous administration of meperidine, there is an increase in peripheral blood flow and a decrease in peripheral arterial and venous resistance, effects that are not blocked by prior oral administration of antihistamines. Intramuscular administration of meperidine does not significantly affect heart rate, but intravenous administration frequently produces an increased rate that is sometimes alarming. As with morphine, respiratory depression is responsible for an accumulation of carbon dioxide, which, in turn, produces cerebral blood flow, and elevation of cerebrospinal fluid pressure.

Gilman, A.G., L.S.Goodman, and A. Gilman. (eds.). Goodman and Gilman's The Pharmacological Basis of Therapeutics. 7th ed. New York: Macmillan Publishing Co., Inc., 1985., p. 514


If a therapeutic dose of /meperidine/ is administered rapidly iv, a generalized increase in muscle tone, including chest wall spasm, may develop; such rigidity also can occur with use of ... morphine.

American Medical Association, Department of Drugs. Drug Evaluations. 6th ed. Chicago, Ill: American Medical Association, 1986., p. 304


... Meperidine is unsuitable for treatment of acute severe pain when the analgesic requirement is exceedingly high or when patients have decreased renal function.

Young, L.Y., M.A. Koda-Kimble (eds.). Applied Therapeutics. The Clinical Use of Drugs. 6th ed. Vancouver, WA., Applied Therapeutics, Inc. 1995., p. 7-10


... The use of narcotics such as meperidine should be limited to severe acute migraine cases in which all other measures have failed. Long-term use of opioids to treat migraine is never indicated.

Hardman, J.G., L.E. Limbird, P.B. Molinoff, R.W. Ruddon, A.G. Goodman (eds.). Goodman and Gilman's The Pharmacological Basis of Therapeutics. 9th ed. New York, NY: McGraw-Hill, 1996., p. 498


Although the duration of respiratory depression produced by meperidine may be shorter than that of morphine, equianalgesic doses of meperidine hydrochloride and morphine sulfate produce the same degree of respiratory depression. The sedative and euphoric effects of equianalgesic doses of meperidine may be greater than those of morphine but reports are conflicting. Meperidine causes little or no constipation and has antitussive activity only in analgesic doses. ... Topical application of the drug produces considerable local anesthesia, but meperidine is not utilized for local anesthesia because it also produces local irritation. /Meperidine hydrochloride/

McEvoy, G.K. (ed.). American Hospital Formulary Service-Drug Information 19 98. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 1998 (Plus Supplements)., p. 1686


... Adverse CNS effects of opiate agonists incl dizziness, visual disturbances, mental clouding or depression, sedation, coma, euphoria, dysphoria, weakness, faintness, agitation, restlessness, nervousness, seizures, and rarely, delirium and insomnia. /Opiate agonists/

McEvoy, G.K. (ed.). American Hospital Formulary Service-Drug Information 19 98. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 1998 (Plus Supplements)., p. 1674


Opiate agonists may cause urinary retention and oliguria. Patients with prostatic hypertrophy or urethral stricture may be more prone to these effects. Opiate agonists may increase the risk of water intoxication in postoperative patients because of stimulation of the release of vasopressin. Suppression of gonadotropic function produced by opiate agonists may cause impotence and a decline in libido, possibly accompanied by decr plasma and urinary concn of 17-ketosteroids. opiate agonists inhibit