Meperidine withdrawal

Patients dependent on narcotics Patients dependent on narcotics may experience withdrawal symptoms upon the administration of nalbuphine. If unduly troublesome, control by slow IV administration of small increments of morphine until relief occurs. If the previous analgesic was morphine, meperidine, codeine or another narcotic... 

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. 

The answers are 264-c, 263-c. (Katzung, pp 519, 535-537.) Heroin and other opioids (such as morphine and meperidine) exhibit a high degree of tolerance and physical dependence. The tolerance rate magnitudes to all of the effects of opioids are not necessarily the same. The physical dependence is quite clear from the character and severity of withdrawal symptoms, which include vomiting spasms, abdominal cramps, diarrhea, and acid-base imbalances among others. 

The time of onset, intensity, and duration of abstinence syndrome depend on the drug previously used and may be related to its biologic half-life. With morphine or heroin, withdrawal signs usually start within 6-10 hours after the last dose. Peak effects are seen at 36-48 hours, after which most of the signs and symptoms gradually subside. By 5 days, most of the effects have disappeared, but some may persist for months. In the case of meperidine, the withdrawal syndrome largely subsides within 24 hours, whereas with methadone several days are required to reach the peak of the abstinence syndrome, and it may last as long as 2 weeks. The slower subsidence of methadone effects is associated with a less intense immediate syndrome, and this is the basis for its use in the detoxification of heroin addicts. However, despite the... 

The signs and symptoms described are typical of withdrawal from physical dependency on an opioid that has efficacy equivalent to a full agonist—in this case, meperidine. Although anxiety, agitation, i... 

Following withdrawal of meperidine after administration of large doses to former morphine addicts for 10 weeks, the signs of abstinence w ere somewhat more severe than those observed after withdrawal from codeine (6). Clinically insignificant abstinence syndromes developed after 75 mg. of meperidine three times daily for 3 months w hile clinically significant syndromes occurred after administration of 75 mg. four times daily for 2 months followed by 75 mg. eight times daily for 2 w eeks. After adminis-... 

Abstinence phenomena after withdrawal from meperidine hydrochloride are milder, come on more rapidly, and subside somewhat more quickly than the phenomena after withdrawal of morphine (50). Meperidine possesses addiction liability which is of a lower order than that of morphine. Yet 5 deaths occurred among the 32 cases of meperidine addiction which Polonio (6) summarized. Meperidine is dangerous when taken in amounts to satisfy dependence. Tremors, toxic psychoses, and convulsions were noted during experimental addiction to meperidine (6, 50). 

In direct addiction of post-addicts to methadone, signs of abstinence on withdrawal were identical with those seen after withdrawal of methadone subsequent to substitution from morphine. The slow recovery from methadone abstinence was more unpleasant to many subjects than abstinence from morphine. Those experimentally addicted to methadone came to prefer methadone to all other drugs. If refused morphine, many addicts will ask for either methadone or meperidine. 

Yawning, rhinorrhea, and cramps are signs of withdrawal from opiates, such as heroin, meperidine, morphine, and methadone. 

Cutaneous reactions associated with quinidine include morbilliform, scalatini-form, and urticarial eruptions (Shatter and Halpern 1958). A case of exfoliative dermatitis has been reported (Taylor and Potashnick 1951), but the patient in addition to taking quinidine was also taking penicillin, codeine sulphate, diphenhydramine, and meperidine. The causal relationship implicating quinidine was established by withdrawing the individual drugs and demonstrating clinical exacerbation with quinidine. 

PCPA blocks the analgesic actions of morphine, methadone, propoxyphene and meperidine.CNS effects of morphine other than analgesia are blocked by PCPA,35 but the findings of Way et al36 that PCPA blocks symptoms accompanying morphine withdrawal have not been confirmed. 

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