Indications for DEMEROL:
Management of acute pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate.
Use lowest effective dose for shortest duration. Oral soln: use calibrated measuring device; dilute each dose in ½ glass of water. Individualize. Initially 50–150mg every 3–4 hours as needed. If pain relief inadequate with ≤600mg/day, taper dose and discontinue; use alternative. Concomitant phenothiazines, other tranquilizers: reduce dose by 25–50%. Concomitant use or discontinuation of CYP2B6/CYP3A4 inhibitors or inducers: monitor closely and consider dose adjustments (see full labeling). Withdraw gradually (esp. if opioid-dependent), taper by ≤10–25% every 2–4 weeks.
Use lowest effective dose for shortest duration. Oral soln: use calibrated measuring device; dilute each dose in ½ glass of water. Individualize. Initially 1.1–1.8mg/kg up to adult dose every 3–4 hours as needed. If pain relief inadequate with ≤600mg/day, taper dose and discontinue; use alternative. Concomitant phenothiazines, other tranquilizers: reduce dose by 25–50%. Concomitant use or discontinuation of CYP2B6/CYP3A4 inhibitors or inducers: monitor closely and consider dose adjustments (see full labeling). Withdraw gradually (esp. if opioid-dependent), taper by ≤10–25% every 2–4 weeks.
Significant respiratory depression. Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment. Known or suspected GI obstruction, including paralytic ileus. During or within 14 days of MAOIs.
Risk of medication errors. Addiction, abuse, and misuse. Risk evaluation and mitigation strategy (REMS). Life-threatening respiratory depression. Accidental ingestion. Neonatal opioid withdrawal syndrome. Cytochrome P450 3A4 interaction. Risks from concomitant use with benzodiazepines or other CNS depressants. Monoamine oxidase inhibitors (MAOIs) interactions.
Ensure accuracy when prescribing, dispensing, and administering oral soln: risk of medication dosing errors due to confusion between mg and mL, and with meperidine solns of different concentrations. Abuse potential (monitor). Life-threatening respiratory depression; monitor within first 24–72hrs of initiating therapy and following dose increases. Accidental exposure may cause fatal overdose (esp. in children). Sleep-related breathing disorders (including central sleep apnea (CSA), sleep-related hypoxemia); consider dose reduction if CSA develops. COPD, cor pulmonale, decreased respiratory reserve, hypoxia, hypercapnia, or pre-existing respiratory depression; monitor and consider non-opioid analgesics. Adrenal insufficiency. Head injury. Increased intracranial pressure, brain tumors; monitor. Seizure disorders. CNS depression. Impaired consciousness, coma, shock; avoid. Biliary tract disease. Acute pancreatitis. Pheochromocytoma. Atrial flutter and other supraventricular tachycardias. Drug abusers. Renal or hepatic impairment. Reevaluate periodically. Avoid abrupt cessation. Elderly. Cachectic. Debilitated. Labor & delivery: not recommended. Pregnancy; potential neonatal opioid withdrawal syndrome during prolonged use. Nursing mothers: monitor infants.
Increased risk of hypotension, respiratory depression, sedation with benzodiazepines or other CNS depressants (eg, non-benzodiazepine sedatives/hypnotics, anxiolytics, general anesthetics, phenothiazines, tranquilizers, muscle relaxants, antipsychotics, alcohol, other opioids); reserve concomitant use in those for whom alternative options are inadequate; limit dosages/durations to minimum required; monitor. Risk of serotonin syndrome with serotonergic drugs (eg, SSRIs, SNRIs, TCAs, triptans, 5-HT3 antagonists, mirtazapine, trazodone, tramadol, cyclobenzaprine, metaxalone, MAOIs, linezolid, IV methylene blue); monitor and discontinue if suspected. Avoid concomitant mixed agonist/antagonist opioids (eg, butorphanol, nalbuphine, pentazocine) or partial agonist (eg, buprenorphine); may reduce effects and/or precipitate withdrawal symptoms. Potentiated by CYP2B6 or CYP3A4 inhibitors (eg, macrolides, azole antifungals, protease inhibitors). Antagonized by CYP2B6 or CYP3A4 inducers (eg, rifampin, carbamazepine, phenytoin). May antagonize diuretics; monitor. Paralytic ileus may occur with anticholinergics. May be potentiated by ritonavir (avoid), acyclovir, cimetidine; monitor.
Lightheadedness, dizziness, sedation, nausea, vomiting, sweating; respiratory depression, severe hypotension, syncope.
Tabs—100; Oral soln—contact supplier