- 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.
- 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.)
| SC | YES |
| IM | YES |
| IV Direct |
YES |
| IV Intermittent Infusion |
YES |
| IV Continuous Infusion |
YES |
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Pediatric:
- 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
Adolescent/Adult:
- 50-150 mg/dose SC/IM/IV Q 3-4 hours PRN
- Infusion: 15-35 mg/hr IV
DOSING ADJUSTMENT IN RENAL IMPAIRMENT:
- CrCl 10-50 mL/minute: Administer 75% of dose
- CrCl <10 mL/minute: Administer 50% of dose
- 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
NURSING MONITORING GUIDELINES:
- 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
SIGNS & SYMPTOMS OF COMPLICATIONS:
- Respiratory depression (RR <10 breaths/minute)
- Somnolence, difficulty in arousing
- Orthostatic hypotension with bradycardia
- Nausea and vomiting
- Allergic reaction.
ACTIONS: Notify physician if:
- Respiratory rate below 10 breaths per minute
- Blood pressure decreased by 25% from baseline
- Patient difficult to rouse
- 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).