Meperidine is indicated for the relief of moderate to severe pain.

Meperidine is contraindicated in patients with hypersensitivity to meperidine.

Meperidine is contraindicated in patients who are receiving monoamine oxidase (MAO) inhibitors or those who have recently received such agents.

Therapeutic doses of meperidine have occasionally precipitated unpredictable, severe, and occasionally fatal reactions in patients who have received such agents within 14 days.

The mechanism of these reactions is unclear, but may be related to a preexisting hyperphenylalaninemia.

Some have been characterized by coma, severe respiratory depression, cyanosis, and hypotension, and have resembled the syndrome of acute narcotic overdose.

In other reactions the predominant manifestations have been hyperexcitability, convulsions, tachycardia, hyperpyrexia, and hypertension.

Although it is not known that other narcotics are free of the risk of such reactions, virtually all of the reported reactions have occurred with meperidine.

If a narcotic is needed in such patients, a sensitivity test should be performed in which repeated, small, incremental doses of morphine are administered over the course of several hours while the patient’s condition and vital signs are under careful observation.

(Intravenous hydrocortisone or prednisolone have been used to treat severe reactions, with the addition of intravenous chlorpromazine in those cases exhibiting hypertension and hyperpyrexia.

The usefulness and safety of narcotic antagonists in the treatment of these reactions is unknown.)

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Hypersensitivity -- Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen.

hyperphenylalaninemia -- any of several autosomal recessive defects in the hydroxylation of phenylalanine resulting in accumulation and excretion of dietary phenylalanine; most commonly the defect is in the enzyme phenylalanine 4-monooxygenase; the most severe manifestation of this is classic PHENYLKETONURIA, but two benign forms also occur; rarely the defect is one of tetrahydrobiopterin metabolism.

comatose -- A profound state of unconsciousness associated with depressed cerebral activity from which the individual cannot be aroused. Coma generally occurs when there is dysfunction or injury involving both cerebral hemispheres or the brain stem RETICULAR FORMATION.

LUNG FUNCTION DECREASED --

Cyanosis -- A bluish or purplish discoloration of the skin and mucous membranes due to an increase in the amount of deoxygenated hemoglobin in the blood or a structural defect in the hemoglobin molecule.

Syndrome -- A symptom complex of unknown etiology, that is characteristic of a particular abnormality.

Convulsions -- the most dramatic type of seizure, characterized by tonic and clonic contraction of most skeletal muscles.

Tachycardia -- Abnormally rapid heartbeat, usually with a HEART RATE above 100 beats per minute for adults. Tachycardia accompanied by disturbance in the cardiac depolarization (cardiac arrhythmia) is called tachyarrhythmia.

Hyperpyrexia --

Hypertensive disease -- Persistently high systemic arterial BLOOD PRESSURE. Based on multiple readings (BLOOD PRESSURE DETERMINATION), hypertension is currently defined as when SYSTOLIC PRESSURE is consistently greater than 140 mm Hg or when DIASTOLIC PRESSURE is consistently 90 mm Hg or more.

Meperidine is an opioid agonist and a Schedule II controlled substance with an abuse liability similar to morphine. Meperidine can be abused in a manner similar to other opioid agonists, legal or illicit.

This should be considered when prescribing or dispensing meperidine in situations where the physician or pharmacist is concerned about an increased risk of misuse, abuse, or diversion.

The following US Branded drugs contain Meperidine Hydrochloride

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ATROPINE AND DEMEROL -- ABBOTT LABORATORIES

MEPERIDINE AND ATROPINE SULFATE -- WYETH AYERST LABORATORIES

DEMEROL -- HOSPIRA INC

DEMEROL -- SANOFI AVENTIS US LLC

MEPERIDINE HYDROCHLORIDE PRESERVATIVE FREE -- ASTRAZENECA LP

MEPERIDINE HYDROCHLORIDE PRESERVATIVE FREE -- HOSPIRA INC

MEPERIDINE HYDROCHLORIDE PRESERVATIVE FREE -- INTERNATIONAL MEDICATION SYSTEM

MEPERIDINE HYDROCHLORIDE PRESERVATIVE FREE -- MALLINCKRODT CHEMICAL INC

MEPERIDINE HYDROCHLORIDE PRESERVATIVE FREE -- WATSON LABORATORIES INC

MEPERGAN -- BAXTER HEALTHCARE CORP ANESTHESIA CRITICAL CARE