Meperidine is alive and well in the new millennium: evaluation of meperidine usage patterns and frequency of adverse drug reactions

Pharmacotherapy
Charles F Seifert, Shalyn Kennedy

Abstract

To report a classic case of normeperidine toxicity, and to present institution-specific data on meperidine usage patterns and the frequency of adverse drug reactions (ADRs). A chart review was conducted of patients at high risk for ADRs. High-risk patients were identified through the pharmacy computer system as those with renal insufficiency (creatinine clearance < or = 50 ml/min), those receiving meperidine with patient-controlled analgesia (PCA), or those receiving more than 200 mg/day of intravenous meperidine for multiple days. Twenty-five percent of patients who received meperidine had some degree of renal insufficiency. The average daily dose of meperidine was 230 mg; cumulative doses ranged from 10-7200 mg. Adverse drug reactions documented in 20 (14%) of 141 patients were confusion, anxiety, nervousness, hallucinations, twitching, and seizure. Sixteen of the 20 patients received meperidine by PCA pump or a combination of PCA and intravenous administration. Patients with ADRs to meperidine were older (58.5 vs 46.4 yrs, p = 0.004), received more concomitant benzodiazepines (65.0% vs 4.1%, p < 0.0001), and had a longer hospital stay (median 9.5 vs 4.6 days, p < 0.001) than those who did not experience an ADR. A significant...Continue Reading

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