Assessment

• Assess type, location, and intensity of pain prior to and 1 hr following PO, subcut, and IM doses and 5 min (peak) following IV administration. When titrating opioid doses, increases of 25–50% should be administered until there is either a 50% reduction in the patient's pain rating on a numerical or visual analogue scale or the patient reports satisfactory pain relief. A repeat dose can be safely administered at the time of the peak if previous dose is ineffective and side effects are minimal

• An equianalgesic chart (see Equianalgesic Dosing Guidelines) should be used when changing routes or when changing from one opioid to another

• Assess blood pressure, pulse, and respirations before and periodically during administration. If respiratory rate is <10/min, assess level of sedation. Dose may need to be decreased by 25–50%. Initial drowsiness will diminish with continued use. Pedi: Neonates and infants are more susceptible to respiratory depression. Assess respiratory rate frequently

• Assess bowel function routinely. Prevention of constipation should be instituted with increased intake of fluids and bulk and with laxatives to minimize constipating effects. Stimulant laxatives should be administered routinely if opioid use exceeds 2–3 days, unless contraindicated

• Prolonged use may lead to physical and psychological dependence and tolerance. This should not prevent patient from receiving adequate analgesia. Most patients who receive meperidine for pain do not develop psychological dependence. Progressively higher doses may be required to relieve pain with long-term therapy

• Monitor patients on chronic or high-dose therapy for CNS stimulation (restlessness, irritability, seizures) due to accumulation of normeperidine metabolite. Risk of toxicity increases with doses >600 mg/24 hr, chronic administration (>2 days), and renal impairment.

• Geri: Meperidine has been reported to cause delirium in the elderly; older adults are at increased risk for normeperidine toxicity. Monitor frequently.

• Pedi: Assess pediatric patient frequently; children are more sensitive to the effects of opioid analgesics and may experience respiratory complications, excitability and restlessness more frequently

• May plasma amylase and lipase concentrations.

• If an opioid antagonist is required to reverse respiratory depression or coma, naloxone (Narcan) is the antidote. Dilute the 0.4-mg ampule of naloxone in 10 ml of 0.9% NaCl and administer 0.5 ml (0.02 mg) by direct IV push every 2 min. For children and patients weighing <40 kg, dilute 0.1 mg of naloxone in 10 ml of 0.9% NaCl for a concentration of 10 mcg/ml and administer 0.5 mcg/kg every 2 min. Titrate dose to avoid withdrawal, seizures, and severe pain.In patients receiving meperidine chronically, naloxone may precipitate seizures by eliminating the CNS depressant effects of meperidine, allowing the convulsant activity of normeperidine to predominate. Monitor patient closely

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