Meperidine is Alive and Well in the New Millennium: Evaluation of Meperidine Usage Patterns and Frequency of Adverse Drug Reactions

Charles F. Seifert, Pharm.D., FCCP; Shalyn Kennedy, Pharm.D.

Disclosures

Pharmacotherapy. 2004;24(6) 

In This Article

Abstract and Introduction

Study Objectives: 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).
Methods: 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 ≤ 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.
Results: 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 difference was found in cumulative PCA doses between patients with and without documented ADRs (median meperidine dose 863 and 455 mg, respectively, p=0.0157). Doses were directly correlated with both renal function (p<0.05) and length of stay (p<0.008). Dosing, duration, and frequency of ADRs for patients using PCA differed significantly between prescribing services (p<0.01).
Conclusion: Patients using PCA meperidine are at particularly high risk of experiencing ADRs based on cumulative doses and duration of treatment. Adverse drug reactions were documented in approximately 14% of patients. Our results warrant restriction of PCA meperidine and evaluation of meperidine usage policies to improve pain management services and decrease the frequency of ADRs.

Meperidine is a synthetic opioid analog frequently prescribed for acute pain; it is metabolized to normeperidine, an active neurotoxic metabolite. Normeperidine is renally excreted and can accumulate in patients with renal dysfunction and in patients receiving high doses for extended periods. Neurotoxic effects include confusion, anxiety, nervousness, hallucinations, and seizures.

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