This opioid analgesic works by activating mu opioid receptors in the CNS and periphery, producing pain relief, sedation, respiratory depression, cough suppression, and decreased intestinal peristalsis.
Meperidine is indicated in the treatment of moderate to severe pain. Frequent dosing may to needed to relieve pain, due to the drug’s short half-life.
Postanesthesia shivering is a phenomenon believed to be caused by a combination of anesthesia-induced hypothermia, and exposure to the cold environment in the operating room. Meperidine is used as a first-line treatment for postanesthesia shivering, as it is effective in reducing the shivering threshold.
Tremors typically indicate an accumulation of a toxic metabolite called normeperidine. Other signs and symptoms of toxicity include seizures, irritability, and dysphoria.
Opioid medications can decrease GI peristalsis and reduce secretion of fluids into the intestines, causing constipation. Laxatives or stool softeners can be used to prevent constipation.
Activation of mu opioid receptors can cause CNS depression, most notably, respiratory depression. Patients should be monitored closely for signs and symptoms of overdose.
The use of meperidine can cause sedation and should be administered cautiously. Patients should be advised to avoid activities, such as driving while taking this medication.
To prevent toxicity, patients should take meperidine for less than 48 hours at a time. Dosing should not exceed 600mg/24hrs due to increased risk for toxicity. Because meperidine is less likely to depress fetal respiration and uterine contractions, it is often the preferred opioid for obstetric use.
When meperidine is taken with MAO inhibitors, selective serotonin reuptake inhibitors, or tricyclic antidepressants, there is excessive activation of serotonin receptors, and decreased reuptake of serotonin. As a result, there is an increased risk for serotonin syndrome, coma and death.
Unlike other opioid medications, meperidine does not cause miosis, or constriction of the pupils.
Meperidine should be used cautiously in patients with renal failure, as metabolites can accumulate in the kidneys, causing toxicity.
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