Meperidine: A Critical Review

Abstract

Meperidine was initially synthesized as an anticholinergic agent but was soon discovered to have analgesic properties. Although meperidine's anticholinergic effects were demonstrated in vivo, the anticholinergic effects on the biliary and renal tracts have not been demonstrated in vivo. Studies have clearly demonstrated that meperidine is no more efficacious in treating biliary or renal tract spasm than comparative mu opioids. The initial studies demonstrating the analgesic efficacy of meperidine were mostly case reports and not double-blind, randomized, controlled trials in specific populations. Subsequent comparative studies failed to demonstrate any advantages of meperidine over comparable doses of other analgesics. Meperidine was portrayed in practice and teaching as having unique clinical advantages. The analgesic effects of meperidine are not pronounced, and, in addition, meperidine use is complicated by unique side effects including serotonergic crisis and normeperidine toxicity. Meperidine's poor efficacy, toxicity, and multiple drug interactions have resulted in a movement to replace meperidine with more efficacious and less toxic opioid analgesics.

Decreased use of petidine in a private hospital with the implementation of a multiprofessional educative program

“…Petidine was synthesized as an anticholinergic agent with espasmolytic function, but its analgesic properties were soon discovered and it started to be used to treat acute pain due to its availability and low cost 9 . Its use was justified because it was believed that it was the best option for cases where the muscarinic effect is undesirable.…”

“…Institutions where petidine prescriptions exceed 10% of total opioid prescriptions during hospitalization are required to have a therapeutic updating program with emphasis on opioids 7 . Studies comparing the postoperative use of morphine and petidine show that due to adverse effects and analgesic potency, petidine is inferior to morphine 9,12 , being indicated by some authors only to control postoperative shivering 9 . However, the treatment of shivering with clonidine, intraoperative body warming and the maintenance of central temperature significantly decrease the incidence of postoperative shivering, challenging the usefulness of pharmacological treatment with petidine 15 .…”

“…In 2006, the Health Department recommended the exclusion of petidine from the list of essential drugs because it is three times more expensive than morphine without any therapeutic advantage 7 . There is consensus not to indicate petidine due to low cost/benefit and efficiency 9,12 , however morphine is recognized as one of the best analgesics to treat severe pain, being the golden standard with regard to analgesic potency 1,2 . In spite of these evidences and of the few data on the use of opioids in Brazilian hospitals, available studies report the excessive petidine consumption 3,14 .…”

Risks associated with drug treatments for kidney stones

“…Rotation of various opioid drugs can be useful in managing tolerance. Meperidine in particular has high risk of developing tolerance 92,93 . It also carries a risk of serotonin syndrome when combined with certain medications, such as antidepressants 94 .…”

Closing Evidence to Practice Gaps in Emergency Care: The Australian Experience

“…Despite this guidance and the lack of good evidence to support its use, 18 pethidine continues to be prescribed in Australian hospitals. An audit of 23 EDs from September 2002 to October 2003 identified migraine as one of the top four documented indications for pethidine prescribing.…”