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Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

(Demerol(R))

Indication

  • used for the treatment of moderate to severe pain
  • not usually a first line analgesic; morphine, or fentanyl, are usually used

Pharmacology

  • meperidine is well absorbed in the gastrointestinal tract; however, approximately 50% of an absorbed dose is removed in the first-pass through the liver
  • reported half-life of meperidine is newborns ranges from 6.5 to 39 h.
  • an active metabolite, normeperidine, can produce CNS stimulation which includes hallucinations, tremors and seizures. This metabolite is eliminated by the kidney and has an elimination half-life of 15 to 20 hours; increasing doses, resulting from the development of tolerance, can lead to accumulation of the toxic metabolite; this is one reason for the recommendation that meperidine be used CAUTIOUSLY, IF AT ALL, in neonates and infants

Side Effects

  • drowsiness, sedation, restlessness, respiratory depression
  • tachycardia, bradycardia and hypotension (due to histamine release)
  • vomiting, sweating, constipation, urinary retention

Precautions

  • use with extreme caution in patients with increased intracranial pressure, seizures, hepatic or renal disease or biliary colic
  • monitor circulatory, respiratory, neurological functions

Dose

  • IV: 0.5 mg/kg q4h prn
  • when administering IV, give by slow IV push over 3 to 5 minutes; dilute to a concentration of 10 mg/mL using 5% DEXTROSE/WATER or a saline solution (eg. 0.9% NaCl)
  • onset of action occurs within 5 minutes after IV administration

Supplied

  • 50 mg/mL, 1 mL ampoule

References

  1. Roberts, RJ: Drug Therapy in Infants, W.B. Saunders, Toronto, 1984.
  2. Bhatt DR, Furman GI, Reber DJ et al: Neonatal Drug Formulary, 1990-1991, 2nd Edition, Fontana, California 92334.
  3. Taketomo CK, Hodding JH and Kraus DM: Pediatric Dosage Handbook, Lexi-Comp Inc., Cleveland, 1992.



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