Opioid analgesic, phenylpiperidine class
ATC code: N02AB02 (Pethidine (meperidine))
Brand names
Demerol
Mu-opioid receptor agonist in the CNS. Also inhibits serotonin reuptake and binds alpha-2 adrenoceptors. Metabolised by CYP3A4 and CYP2B6 to active normeperidine with long half-life (15–20 hours) and neurotoxicity on accumulation (seizures, delirium). 10-fold weaker analgesic than morphine. Widely used perioperatively in Spain as Dolantina.
Second line
Meperidine is used for acute postoperative pain and renal colic when morphine is contraindicated. In Spain Dolantina is historically used in obstetrics and perioperative care. SED has since 2020 recommended restricting use due to normeperidine neurotoxicity on repeated doses and high risk of fatal serotonin syndrome with MAO inhibitors and SSRIs.
4 pairs found. Sorted from critical to minor.
Mechanism
Linezolid is a reversible MAO inhibitor. With meperidine – serotonin syndrome.
Symptoms
Hyperthermia, myoclonus.
Management
Combination contraindicated.
Mechanism
Meperidine inhibits serotonin reuptake. With phenelzine (MAOI) causes fatal serotonin syndrome. boxed warning.
Symptoms
Hyperthermia above 39°C, myoclonus, coma within hours.
Management
Combination contraindicated. At least 14 days between MAOI withdrawal and meperidine. Alternative – morphine or fentanyl.
Mechanism
Ritonavir inhibits CYP3A4 (meperidine metabolism) while inducing formation of neurotoxic normeperidine. Seizure risk.
Symptoms
Seizures, delirium.
Management
Combination contraindicated. Alternative – fentanyl.
Mechanism
Same pharmacodynamics – fatal serotonin syndrome.
Symptoms
Hyperthermia, myoclonus, coma.
Management
Combination contraindicated.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
In Spain Dolantina is used in labour. Long-term third-trimester use risks neonatal withdrawal syndrome.
Passes into milk. After single labour dose breastfeeding is possible with infant drowsiness monitoring.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Meperidine is evaluated for the following indications with varying evidence strength: Postoperative pain (evidence tier B). See the full indication matrix with dosing and citations above on this page.
Common side effects of Meperidine (≥ 1 in 100): Nausea, vomiting, Sedation, Constipation, Dizziness, Dry mouth. See the Safety section for uncommon and serious reactions.
FDA category C. In Spain Dolantina is used in labour. Long-term third-trimester use risks neonatal withdrawal syndrome.
Passes into milk. After single labour dose breastfeeding is possible with infant drowsiness monitoring.
Meperidine is contraindicated in: MAO inhibitors (phenelzine, tranylcypromine) and within 14 days of withdrawal – fatal serotonin syndrome; Linezolid, methylene blue; Selegiline; Severe renal impairment (normeperidine accumulation); Prior seizures. Full list in the Safety section.