Parenteral Manual

Meperidine HCl

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Narcotic analgesic
Original Date: 
August 2005
Revised Date: 
December 2019
  • Relief of moderate to severe pain
  • An adjunct to anesthesia and preoperative sedation
  • Morphine is the preferred drug - Meperidine is not recommended in renal failure, hepatic failure, history of seizures or at maximum doses for greater than 24 hours due to seizure potential of metabolite, normeperidine.
Reconstitution and Stability: 
  • Store at room temperature. Protect from light
  • Available as a 50 mg/mL solution
  • Stable 28 days room temp or refrigerate at concentrations of 0.25 - 30 mg/mL.

- Solutions Compatible: dextrose up to D10W, NS, dextrose-saline combinations, ringer's solution, ringer's lactate

- Additive/Above Cassette Compatible: atropine, chlorpromazine, dimenhydrinate, diphenhydramine,  fentanyl, glycopyrrolate, hydroxyzine, metoclopramide, midazolam, ranitidine, scopolamine for 15 minutes

- Y-site Compatible: clindamycin, dopamine, erythromycin, fluconazole, KCl, metronidazole, TPN (amino acids/dextrose),  vancomycin 

- Incompatible: aminophylline, imipenem-cilastatin, furosemide, morphine, phenytoin, phenobarbital, pentobarbital, sodium bicarbonate.  Heparin;  heparin locks must be flushed with NS before and after meperidine administration


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

IV Direct

Usual dilution: 10 mg/mL
Infusion time: >  5 minutes
Infusion rate: do not exceed 25 mg/minute

IV Intermittent Infusion

Usual dilution: 10 mg/mL
Infusion time: 15-30 minutes

IV Continuous Infusion

Usual dilution: 1-10 mg/mL


(For neonatal dosages, refer to Neonatal IV Drug Manual.)


  • 1-2 mg/kg/dose SC/IM/IV 5 minutes before procedure
  • 1-1.5 mg/kg/dose SC/IM/IV Q 3-4 hours PRN
  • Maximum: 100 mg/dose
  • Infusion: 0.5-1 mg/kg IV loading dose followed by initial rate of 0.3 mg/kg/hr, titrate up to 0.5-0.7 mg/kg/hr


  • 50-150 mg/dose SC/IM/IV Q 3-4 hours PRN
  •  Infusion: 15-35 mg/hr IV


  • CrCl 10-50 mL/minute:  Administer 75% of dose
  • CrCl <10 mL/minute:  Administer 50% of dose
Potential hazards of parenteral administration: 
  • Respiratory depression, tachycardia, hypotension, bradycardia, palpitations, peripheral vasodilation
  • CNS depression, drowsiness, dizziness, increased intracranial pressure, tremors, seizures
  • ADH release, pruritus, nausea, vomiting, constipation
  • Biliary tract spasm, urinary tract spasm
  • Contraindicated in patients using MAOIs (within 14 days)- greatly potentiate the effects of meperidine
  • 75-100 mg meperidine IM = 10 mg morphine IM


  • Check physician's order against guidelines; question dosage if higher.
  • Safely prepare and administer medication as per Medication Administration Policy.
  • Continuous infusion must be on a pump.
  • 02 and suction must be available at bedside
  • Patient may need to be on a respiratory monitor (or Oximeter) if there are concerns
  • IV solution without the added narcotic must be available at bedside with tubing primed, ready to be hooked to patient in case of an emergency.

Monitor: Level of consciousness, respiratory rate, BP and pulse:

  • just prior to beginning therapy
  • then every 5 minutes for 15 minutes after the initial dose or an increase in infusion rate
  • then monitor respiratory rate and pulse Q1H × 4 hours thereafter as directed.
  • Naloxone must be available in the patient care area as ward stock


  • Respiratory depression (RR <10 breaths/minute)
  • Somnolence, difficulty in arousing
  • Orthostatic hypotension with bradycardia
  • Nausea and vomiting
  • Allergic reaction.

ACTIONS: Notify physician if:

  1. Respiratory rate below 10 breaths per minute
  2. Blood pressure decreased by 25% from baseline
  3. Patient difficult to rouse
  4. Allergic reaction
  • Stop infusion of narcotic and start plain IV solution.  Notify physician.
  • Maintain patient airway and administer O2 as indicated.
  • Contact Pharmacy, Anesthesia, or Poison Information Centre if after hours, for appropriate dose of naloxone (Narcan).

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