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Demerol is a prescription medicine used to treat the symptoms of moderate to severe pain. Demerol may be used alone or with other medications.


Description

Demerol Uses

Meperidine is used to help relieve moderate to severe pain. It may also be used before and during surgery or other procedures. Meperidine belongs to a class of drugs known as opioid analgesics and is similar to morphine. It works in the brain to change how your body feels and responds to pain.

Meperidine should not be used to treat long-term or ongoing pain. It should only be used to treat sudden episodes of moderate to severe pain. See also Precautions section.

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How to use Demerol Vial

This medication is given by injection into a vein, into a muscle, or under the skin as directed by your doctor.

If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.

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When meperidine is injected into a vein, it is given very slowly to prevent serious side effects. If this medication is given into a muscle or under the skin, it is important to change the injection site each time to lessen injury under the skin. You should be lying down when the injection is given to prevent side effects such as dizziness.

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The dosage is based on your medical condition and response to treatment. Do not increase your dose or use this drug more often or for longer than prescribed because your risk of side effects may increase. Properly stop the medication when so directed.

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Pain medications work best if they are used as the first signs of pain occur. If you wait until the pain has worsened, the medication may not work as well.

If you have nausea, ask your doctor or pharmacist for ways to decrease it (such as lying down with as little head movement as possible).

Suddenly stopping this medication may cause withdrawal, especially if you have used it for a long time or in high doses. To prevent withdrawal, your doctor may lower your dose slowly. Tell your doctor or pharmacist right away if you have any withdrawal symptoms such as restlessness, mental/mood changes (including anxietytrouble sleeping, thoughts of suicide), watering eyesrunny nose, nausea, diarrheasweating, muscle aches, or sudden changes in behavior.

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When this medication is used for a long time, it may not work as well. Talk with your doctor if this medication stops working well.

Though it helps many people, this medication may sometimes cause addiction. This risk may be higher if you have a substance use disorder (such as overuse of or addiction to drugs/alcohol). Use this medication exactly as prescribed to lower the risk of addiction. Ask your doctor or pharmacist for more details.

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Demerol Side Effects

Nauseavomitingconstipationsweatinglightheadednessdizziness, drowsiness, or pain/redness at the injection site may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

To prevent constipation, eat dietary fiber, drink enough water, and exercise. You may also need to take a laxative. Ask your pharmacist which type of laxative is right for you.

To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

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Tell your doctor right away if you have any serious side effects, including: interrupted breathing during sleep (sleep apnea), mental/mood changes (such as agitation, confusion, hallucinations), stomach/abdominal pain, difficulty urinating, slow/irregular/fast heartbeat, shaking (tremors), vision changes, signs of your adrenal glands not working well (such as loss of appetite, unusual tiredness, weight loss).

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Get medical help right away if you have any very serious side effects, including: faintingseizure, severe drowsiness/difficulty waking up.

This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrheatwitching muscles, unexplained fever, unusual agitation/restlessness.

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A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rashitching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

Demerol Precautions

Before using meperidine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

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Before using this medication, tell your doctor or pharmacist your medical history, especially of: brain disorders (such as head injury, tumor, seizures), breathing problems (such as asthmasleep apneachronic obstructive pulmonary diseaseCOPD), gallbladder disease, kidney diseaseliver disease, mental/mood disorders (such as confusion, depression, thoughts of suicide), personal or family history of a substance use disorder (such as overuse of or addiction to drugs/alcohol), stomach/intestinal problems (such as blockage, constipationdiarrhea due to infection, paralytic ileus), disease of the pancreas (pancreatitis), difficulty urinating (such as due to enlarged prostate), pheochromocytomaheart problems (such as fast/irregular heartbeat), sickle cell anemia.

Meperidine is usually used only for a short time. Repeated or high doses may cause drug levels to build up in the body and cause serious side effects such as seizures and shaking. Caution is advised if this medication is used for conditions that require long-term or high-dosage treatment (such as sickle cell anemia, burns, cancer). Consult your doctor or pharmacist for details.

This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Older adults may be more sensitive to the side effects of this drug, especially confusion, dizziness, drowsiness, and slow/shallow breathing.

Children may be more sensitive to the side effects of this drug, especially severe drowsiness and slow/shallow breathing.

During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. Discuss the risks and benefits with your doctor. (See also Warning section.)

This drug passes into breast milk and may have undesirable effects on a nursing infant. Tell the doctor right away if your baby develops unusual sleepiness, difficulty feeding, or trouble breathing. Consult your doctor before breast-feeding.

 

Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Some products that may interact with this drug include: certain pain medications (mixed opioid agonist-antagonists such as pentazocine, nalbuphine, butorphanol), naltrexone.

Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazidlinezolid, methylene blue, moclobemide, phenelzineprocarbazinerasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication.

The risk of serious side effects (such as slow/shallow breathing, severe drowsiness/dizziness) may be increased if this medication is used with other products that may also cause drowsiness or breathing problems. Tell your doctor or pharmacist if you are taking other products such as other opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolamlorazepam, zolpidem), muscle relaxants (such as carisoprodolcyclobenzaprine), or antihistamines (such as cetirizinediphenhydramine).

Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/”ecstasy,” St. John’s wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.

Other medications can affect the removal of meperidine from your body, which may affect how meperidine works. Examples include azole antifungals (such as ketoconazole), macrolide antibiotics (such as erythromycin), mifepristone, rifamycins (such as rifabutin), ritonavir, drugs used to treat seizures (such as carbamazepine, phenytoin), among others.

This medication may interfere with certain laboratory tests (including amylase/lipase tests), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, give them naloxone if available, then call 911. If the person is awake and has no symptoms, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: slow/shallow breathing, severe drowsiness, coma.

Notes

Do not share this medication with others. Sharing it is against the law.

This medication has been prescribed for your current condition only. Do not use it later for another condition unless your doctor directs you to do so. A different medication may be necessary in that case.

Ask your doctor or pharmacist if you should have naloxone available to treat opioid overdose. Teach your family or household members about the signs of an opioid overdose and how to treat it.

Missed Dose

Not applicable.

Storage

Different products have different storage needs. Check the product package for instructions on how to store your brand, or ask your pharmacist. Keep all medications away from children and pets.

What is Demerol and how is it used?

Demerol is a prescription medicine used to treat the symptoms of moderate to severe pain. Demerol may be used alone or with other medications.

Demerol belongs to a class of drugs called Synthetic, Opioids, Opioid Analgesics.

What are the possible side effects of Demerol?

Demerol may cause serious side effects including:

  • slow heartrate,
  • weak or shallow breathing,
  • breathing that stops during sleep,
  • severe drowsiness,
  • lightheadedness,
  • confusion,
  • mood changes,
  • severe constipation
  • ,
  • tremors,
  • muscle movements you can’t control,
  • seizure (convulsions)
  • nausea,
  • vomiting,
  • loss of appetite,
  • dizziness,
  • worsening tiredness, and
  • weakness

Get medical help right away, if you have any of the symptoms listed above.

The most common side effects of Demerol include:

  • dizziness,
  • drowsiness,
  • nausea,
  • vomiting, and
  • sweating

Tell the doctor if you have any side effect that bothers you or that does not go away.

These are not all the possible side effects of Demerol. For more information, ask your doctor or pharmacist.

DEMEROL (meperidine hydrochloride, USP) Tablet and Oral Solution are opioid agonists. DEMEROL Tablets are available as 50 mg and 100 mg Tablets for oral administration. The chemical name is 4-Piperidinecarboxylic acid, 1-methyl-4-phenyl-,ethyl ester, hydrochloride. The molecular weight is 283,80. Its molecular formula is C15H21NO2· HCl, and it has the following chemical structure.

 

 

DEMEROL® (meperidine hydrochloride) Structural Formula Illustration

 

Meperidine 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.

The Tablets contain 50 mg or 100 mg of meperidine hydrochloride.

The DEMEROL Oral Solution is a pleasant-tasting, nonalcoholic, banana-flavored solution containing 50 mg of meperidine hydrochloride, per 5 mL (10 mg/mL).

The Inactive Ingredients in DEMEROL Tablets include: Calcium Sulfate, Dibasic Calcium Phosphate, Starch, Stearic Acid, and Talc. The Tablets are white, round and convex. The 50 mg is a scored tablet and has a stylized “W” on one side and “D” over “35” on the other side. The 100 mg is a scored tablet and has a stylized “W” on one side and “D” over “37” on the other side.

The Inactive Ingredients in DEMEROL Oral Solution include: Benzoic Acid, Flavor, Liquid Glucose, Purified Water, Saccharin Sodium.

INDICATIONS

DEMEROL Tablets and Oral Solution are indicated for the management of acute pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate.

Limitations Of Use

Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses [see WARNINGS AND PRECAUTIONS], reserve DEMEROL Tablets or Oral Solution for use in patients for whom alternative treatment options [e.g., non-opioid analgesics or opioid combination products]:

  • Have not been tolerated, or are not expected to be tolerated,
  • Have not provided adequate analgesia, or are not expected to provide adequate analgesia.

DEMEROL Tablets or Oral Solution should not be used for treatment of chronic pain. Prolonged DEMEROL Tablet or Oral Solution use may increase the risk of toxicity (e.g. seizures) from the accumulation of the meperidine metabolite, normeperidine.


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DOSAGE AND ADMINISTRATION

Important Dosage And Administration Instructions

Ensure accuracy when prescribing, dispensing, and administrating DEMEROL Oral Solution to avoid dosing errors due to confusion between mg and mL, and with other Meperidine Hydrochloride Oral Solutions of different concentrations, which could result in accidental overdose and death. Ensure the proper dose is communicated and dispensed. When writing prescriptions, include both the total dose in mg and the total dose in volume.

Do not use household teaspoons or tablespoons to measure DEMEROL Oral Solution, as using a tablespoon instead of a teaspoon could lead to overdosage.

Use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals [see WARNINGS AND PRECAUTIONS].

Dilute each dose of DEMEROL oral solution in one-half glass of water because the undiluted solution may exert a slight topical anesthetic effect on mucous membranes.

Initiate the dosing regimen for each patient individually; taking into account the patient’s severity of pain, patient response, prior analgesic treatment experience, and risk factors for addiction, abuse, and misuse [see WARNINGS AND PRECAUTIONS].

Monitor patients closely for respiratory depression, especially within the first 24-72 hours of initiating therapy and following dosage increases with DEMEROL Tablets or Oral Solution and adjust the dosage accordingly [see WARNINGS AND PRECAUTIONS].

Initial Dosage

Adults

Initiate treatment with DEMEROL Tablets or Oral Solution in a dosing range of 50 mg to 150 mg orally, every 3 or 4 hours as needed for pain.

Pediatric Patients

Initiate treatment with DEMEROL Tablets or Oral Solution in a dosing range of 1.1 mg/kg to 1.8 mg/kg orally, up to the adult dose, every 3 or 4 hours as necessary.

Dosage Modification With Concomitant Use With Phenothiazines

The dose of DEMEROL Tablets or Oral Solution should be reduced by 25 to 50% when administered concomitantly with phenothiazines and other tranquilizers.

Titration And Maintenance Of Therapy

Individually titrate DEMEROL Tablets and Oral Solution to a dose that provides adequate analgesia and minimizes adverse reactions. If adequate pain management cannot be achieved with a total daily dosage of 600 mg or less, discontinue treatment with DEMEROL Tablets or Oral Solution by tapering the dose and select an alternate analgesic.

Continually reevaluate patients receiving DEMEROL Tablets or Oral Solution to assess the maintenance of pain control and the relative incidence of adverse reactions, as well as monitoring for the development of addiction, abuse, or misuse [see WARNINGS AND PRECAUTIONS]. Frequent communication is important among the prescriber, other members of the healthcare team, the patient, and the caregiver/family during periods of changing analgesic requirements, including initial titration.

If the level of pain increases after dosage stabilization, attempt to identify the source of increased pain before increasing the DEMEROL Tablets or Oral Solution dosage. If unacceptable opioid-related adverse reactions are observed, consider reducing the dosage. Adjust the dosage to obtain an appropriate balance between management of pain and opioid-related adverse reactions.

Discontinuation Of DEMEROL Tablets Or Oral Solution

When a patient who has been taking DEMEROL Tablets or Oral Solution regularly and may be physically dependent no longer requires therapy with DEMEROL Tablets or Oral Solution, taper the dose gradually, by 25% to 50% every 2 to 4 days, while monitoring carefully for signs and symptoms of withdrawal. If the patient develops these signs or symptoms, raise the dose to the previous level and taper more slowly, either by increasing the interval between decreases, decreasing the amount of change in dose, or both. Do not abruptly discontinue DEMEROL Tablets or Oral Solution in a physically-dependent patient. [see WARNINGS AND PRECAUTIONSDrug Abuse And Dependence].

Meperidine appears in the milk of nursing mothers receiving the drug. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for DEMEROL Tablets or Oral Solution and any potential adverse effects on the breastfed infant from DEMEROL Tablets or Oral Solution or from the underlying maternal condition.

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