Medicines Meperidine

Further chemical modification of the phenylpiperidine moiety has proven unusually fruitful in producing medicinal agents that affect the central nervous system. First, a series of compounds loosely related to the reversed meperidines produced several drugs with important antipsychotic activity. Further discussion of this pharmacologic activity, often referred to as major tranquilizer activity, will be found in the section on phenothiazines. The group led by Janssen took advantage of the chemistry of the... 

Morphine, when extracted from raw opium and treated chemically, yields the semisynthetic narcotics hydromorphone, oxymorphone, oxycodone, and heroin. Heroin is an illegal narcotic in the United States and is not used in medicine. Synthetic narcotics are those man-made analgesics with properties and actions similar to the natural opioids. Examples of synthetic narcotic analgesics are methadone, levorphanol, remifen-tanil, and meperidine Additional narcotics are listed in the Summary Drug Table Narcotic Analgesics. 

Szeto HH, Inturrisi CE, Houde R, Saal S, Cheigh J and Reidenberg M (1977). Accumulation of norperidine, an active metabolite of meperidine [pethidine], in patients with renal failure or cancer. Annals of Internal Medicine, 86, 738-741. 

Opiates are compounds extracted from the milky latex contained in the unripe seed pods of the opium poppy (Papaver somniferum). Opium, morphine, and codeine are the most important opiate alkaloids found in the opium poppy. Opium was used as folk medicine for hundreds, perhaps thousands of years. In the seventeenth century opium smoking led to major addiction problems. In the first decade of the nineteenth century, morphine was isolated from opium. About 20 years later, codeine, one-fifth as strong as morphine, was isolated from both opium and morphine. In 1898, heroin, an extremely potent and addictive derivative of morphine was isolated. The invention of the hypodermic needle during the mid-nineteenth century allowed opiates to be delivered directly into the blood stream, which increases the effects of these drugs. Synthetically produced drugs with morphine-like properties are called opioids. The terms narcotic, opiate, and opioid are frequently used interchangeably. Some common synthetically produced opioids include meperidine (its trade name is Demerol) and methadone, a drug often used to treat heroin addiction. 

Goetting MG and Thirman MJ (1985) Neurotoxicity of meperidine. Annals of Emergency Medicine 14 1007-1009. 

Opioid drugs and peptides that bind to the opioid receptors produce the primary general and specific clinical effects summarized in Table 8.1. The opioids relevant to this review are those that are used in medicine today meaiung, therefore, the frequently administered analgesics, particularly morphine, codeine, and synthetic analogs such as fentanyl, meperidine, and methadone. 

Meperidine is an older opioid analgesic with typical annoying and occasionally serious adverse events such as respiratory depression. It is also associated with significant risks of cortical irritahility and potential neurotoxicity. Meperidine may provide useful relief of visceral pain, post-operative shivering, and sickle cell crisis-related pain however, because of its adverse event profile, its role in modern pain medicine is becoming increasingly limited [4]. 

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