Meperidine adverse effects

Amphotericin B is the mainstay of treatment of patients with severe endemic fungal infections. The conventional deoxycholate formulation of the drug can be associated with substantial infusion-related adverse effects (e.g., chills, fever, nausea, rigors, and in rare cases hypotension, flushing, respiratory difficulty, and arrhythmias). Pre-medication with low doses of hydrocortisone, acetaminophen, nonsteroidal anti-inflammatory agents, and meperidine is common to reduce acute infusion-related reactions. Venous irritation associated with the drug can also lead to thrombophlebitis, hence central venous catheters are the preferred route of administration in patients receiving more than a week of therapy. 

Geriatric Considerations - Summary Diphenoxylate is an analog of meperidine and can cause opiate adverse effects. When discontinued, physical dependence and withdrawal symptoms can occur. Adverse GI effects such as constipation, nausea/vomit-ing, and abdominal pain may result from normal doses. Afropine is added to discourage abuse but can cause anticholinergic adverse effects in the older adult. The benefits of f his drug combination for older adulfs are limifed by fhe risk of adverse effects. 

Neither selegiline nor rasagiline should be taken by patients receiving meperidine. They should be used with care in patients receiving tricyclic antidepressants or serotonin reuptake inhibitors because of the theoretical risk of acute toxic interactions of the serotonin syndrome type (see Chapter 16), but this is rarely encountered in practice. The adverse effects of levodopa may be increased by these drugs. 

T effects OF amiodarone, astemizole, atorvastadn, barbiturates, bepridil, bupropion, cerivastatin, cisapride, clorazepate, clozapine, clarithromycin, desipramine, diazepam, encainide, ergot alkaloids, estazolam, flecainide, flurazepam, indinavir, ketoconazole, lovastatin, meperidine, midazolam, nelfinavir, phenytoin, pimozide, piroxicam, propafenone, propoxyphene, quinidine, rifabutin, saquinavir, sildenafil, simvastatin, SSRIs, TCAs, terfenadine, triazolam, troleandomycin, zolpidem X effects W/ barbiturates, carbamazepine, phenytoin, rifabutin, rifampin, St. John s wort, tobacco X effects OF didanosine, hypnotics, methadone, OCPs, sedatives, theophylline, warfarin EMS T Effects of amiodarone, diazepam, midazolam and BBs, may need X- doses concurrent use of Viagra-type drugs can lead to hypotension X- effects of warfarin concurrent EtOH use can T adverse effects T glucose ODs May cause an extension of adverse SEs symptomatic and supportive Rivasrigmine (Exelon) [Cholinesterase Inhibitor/Anri ... 

Adverse effects Large doses of meperidine cause tremors, muscle twitches, and rarely, convulsions. The drug differs from opioids in that in large doses it dilates the pupil and causes hyperactive reflexes. Severe hypotension can occur when the drug is administered postoperatively. When used with major neuroleptics, depression is greatly enhanced. Administration to patients taking monoamine oxidase inhibitors (see p. 123) can provoke severe reactions such as convulsions and hyperthermia. Meperidine can cause dependence, and can substitute for morphine or heroin in use by addicts. Cross-tolerance with the other opioids occurs. 

Pruritus is a frequent adverse effect after intrathecal administration, with an incidence of one-third with bupre-norphine (122) and diamorphine (123) and over 70% for both diamorphine and morphine (124,125). In one stndy the incidence of pruritns was higher with morphine than with methadone analgesia was also snperior (124). Pruritus has also been reported with intrathecal pethidine (meperidine). Treatment was not reported to be necessary. This effect is not reported to occnr after intrathecal beta-endorphin (126,127). The mechanism of prnritns is not well understood and has been attribnted to a distnr-bance of thiamine metabolism (128) and to a distnrbance of afferent inpnt at snpraspinal as well as at spinal receptor sites (129). 

Many cases of serious (some fatal) adverse effects have been reported when meperidine is added to an MAOi (phenelzine or tranylcypromine). 

Toxicity Adverse effects include insomnia, mood changes, dyskinesias, gastrointestinal distress, and hypotension. Meperidine in combination with selegiline has caused agitation, delirium, and death. Selegiline has been implicated in the serotonin syndrome when used in patients taking selective serotonin reuptake inhibitors (see Chapter 30). 

Johnson R, Douglas J, Corey L, Krasney H Adverse effects with acyclovir and meperidine Atm Intern Med(mS) 103.962-3... 

The monoamine oxidase inhibitors (MAOIs) work through augmented activity of dopamine, as monoamine oxidase normally degrades norepinephrine and serotonin. The MAOIs are rarely used clinically due to their adverse effects, notably orthostatic hypotension, peripheral edema, myoclonic jerks, weakness, and insomnia. Hypertensive crisis can result when combined with sympathomimetics, including over-the-counter products such as ephe-drine and pseudoephedrine. Further, MAOIs are known to contribute to the serotonin syndrome and use of meperidine must be avoided in such patients. Patients on MAOI need to restrict tyramine-rich foods, as well [1,2]. 

Fentanyl is a synthetic opioid analgesic, introduced in the 1950s, that has enhanced analgesic activity and potency and fewer adverse effects compared with morphine or meperidine. Structurally related to meperidine, fentanyl gained wide popularity as an intra-operative anesthetic adjunct as well as an effective analgesic for the management of acute and chronic pain. 

Renal/Hepatic function impairment Renal and hepatic dysfunction may cause a prolonged duration and cumulative effect smaller doses may be necessary. Meperidine In patients with renal dysfunction, normeperidine (an active metabolite of meperidine) may accumulate, resulting in increased CNS adverse reactions. Pregnancy Category C, Category B, (oxycodone). 

Medications with serotonergic activity may also have other monaminergic or sympathomimetic activity. Combining MAOIs with these medications may result in a complex side effect profile. For example, combining meperidine or dextromethorphan with MAOIs may result in respiratory depression, in addition to symptoms of serotonin excess. Furthermore, interactions between MAOIs and tricyclic antidepressants (TCAs) more commonly result in potentiating shared adverse events such as othostatic hypotension, as opposed to hyperadrenergic crises or the serotonin syndrome. 

Whereas these and other beneficial drug interactions are well known and often used in clinical practice, some interactions that are currently considered to be adverse also may be applied therapeutically. For example, the analgesic effects of meperidine and the opiates are augmented by the concurrent administration of MAO inhibitors. This interaction can be used to increase the desirable effects of the analgesics without having to increase the dose. The regimen may have a place in the relief of severe chronic pain in patients with terminal malignant disease. 

---