Meperidine drug interactions

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. 

Drug interactions serotonin syndrome includes diaphoresis, rigidity, myoclonus, hyperthermia, ANS instability, and seizures. Has been reported for SSRIs when used with MAOIs, TCAs, meperidine, and dextromethorphan. 

Drug interactions serotonin syndrome with MAO inhibitors, TCAs, meperidine and dextromethorphan... 

Drug interactions The most important drug interactions involving opioid analgesics are additive CNS depression with ethanol, sedative-hypnotics, anesthetics, antipsychotic drugs, tricyclic antidepressants, and antihistamines. Concomitant use of certain opioids (eg, meperidine) with MAO inhibitors increases the incidence of hyperpyrexic coma. Meperidine has also been implicated in the serotonin syndrome when used together with selective serotonin rcuptake inhibitors. 

Meperidine has a strong adverse reaction when given to patients receiving a monoamine oxidase inhibitor. This drug interaction has been seen recently in patients with Parkinson s disease taking the monoamine oxidase-selective inhibitor selegiline (Eldepryl). 

Stambaugh JE, Wainer IW, Hemphill DM, Schwartz I. A potentially toxic drug interaction between pethidine (meperidine) and [henobaibitone. Lancet (1977) i, 398-9. 

Stambaugh JE, Wainer IW. Drug interactions I meperidine and ccmbination oral caitracep-... 

Drugs that may interact with selegiline include fluoxetine and meperidine. 

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. 

Phenelzine Blockade of MAO-A and MAO-B (phenelzine, nonselective) MAO-B irreversible selective MAO-B inhibition (low dose selegiline) Transdermal absorption of selegiline achieves levels that inhibit MAO-A Major depression unresponsive to other drugs Very slow elimination Toxicity Hypotension, insomnia Interactions Hypertensive crisis with tyramine, other indirect sympathomimetics serotonin syndrome with serotonergic agents, meperidine... 

Lopinavir/Ritonavir (Kaletra) [Anrirelroviral/Protease Inhibitor] Uses HIV Infxn Action Protease inhibitor Dose Adults. Tx naive 2 tab PO daily or 1 tab PO bid Tx experiencedpt 1 tab PO bid (T dose if w/ amprenavir, efavirenz, fosamprenavir, nelfinavir, nevirapine) Peds. 7-15 kg 12/3 mg/kg PO bid 15-40 kg 10/2.5 mg/kg PO bid >40 kg Adult dose w/ food Caution [C, /-] Numerous interactions Contra w/drugs dependent on CYP3A/CYP2D6 (Table VI-8) Disp Tab, soln SE Avoid disulfiram (soln has EtOH), metronidazole GI upset, asthenia, T cholesterol/triglycerides, pancreatitis protease metabolic synd Interactions T Effects Wl clarithromycin, erythromycin T effects OF amiodarone, amprenavir, azole andfungals, bepridil, cisapride, cyclosporine, CCBs, ergot alkaloids, flecainide, flurazepam, HMG-CoA reductase inhibitors, indinavir, lidocaine, meperidine, midazolam, pimozide, propafenone, propoxyphene, quinidine, rifabutin, saquinavir, sildenafil, tacrolimus, terfenadine, triazolam, zolpidem 1 effects Wl barbiturates, carbamazepine, dexamethasone, didanosine, efavirenz, nevirapine, phenytoin, rifabutin, rifampin, St. John s wort 1 effects OF OCPs, warfarin EMS Use andarrhythmics and benzodiazepines... 

Denson DD, Myers JA, Coyle DE. The clinical relevance of the drug displacement interaction between meperidine and bupivacaine. Res Commun Chem Pathol Pharmacol 1984 45(3) 323-30. 

The metabolite may have pharmacologic activity similar to that of the parent drug and thus contribute significantly to clinical response for example, oxypurinol and desacetyl cefotaxime. Alternatively, the metabolite may have qualitatively dissimilar pharmacologic action for example, normeperidine has central nervous system (CNS)-stimulatory activity that reportedly produces seizures, whereas meperidine has CNS-depressant actions. " Because of the multiplicity of potential interactions of compounds that are primarily metabolized, the practical consequences of metabolite accumulation are difficult to predict and are most often identified in those patients at risk by trial and error (Table 48-5). 

A patient injured in an auto accident received 80 mg of meperidine. He subsequently developed a severe reaction characterized by tachycardia, hypertension, hyperpyrexia, and seizures. When questioned, the uninjured spouse revealed that the patient had been taking a drug for a psychiatric condition. Which of the following drugs is most likely to be responsible for this untoward interaction with meperidine ... 

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