Seizures and Meperidine: Overstated and Underutilized

Abstract

Meperidine is used for pain control and treatment of shivering. Concerns about neurotoxicity, particularly seizures, have led to efforts limiting meperidine use. We reviewed the body of evidence linking meperidine to seizures. We searched PubMed for the terms meperidine, normeperidine, pethidine, and norpethidine; each was combined with the terms: seizure, epilepsy, epileptogenic, toxicity, overdose, seizure threshold, and convulsion. Articles were assessed for relevance. Semiologies were reviewed to ascertain seizure likelihood. Our search yielded 351 articles, of which 66 were relevant. Of these, 33 had primary clinical data on meperidine-associated seizures, comprising 50 patients. Twenty events were deemed likely to be seizures, 26 indeterminate, and 4 unlikely. Most studies were case reports. Confounding comorbidities were frequent. The evidence base for meperidine-associated seizures in man is scant. Seizure risk associated with meperidine appears to be overstated. The utility of meperidine should continue to be explored, especially for therapeutic hypothermia.

Tramadol vs. pethidine to control perioperative shivering in cesarean section under spinal anesthesia: a double-blind study

“…7 Pethidine usage has been associated with several undesirable side effects related to its metabolite norpethidine, including the propensity for epileptic activities. 8 Tramadol is an analgesic agent and its mechanism of action is through inhibition of the reuptake of 5hydroxytryptamine-3 (5-HT3) and norepinephrine. 9 These actions have been associated with thermoregulation and have led to its use as an antishivering agent.…”

Meperidine-induced Seizure in an Adult Patient with Lung Lesions

“…Schlick et al . [ 4 ] wrote an excellent review about meperidine-induced seizures. Based on their work and combined with the latest search results, we identified 35 clinically relevant studies of meperidine-associated seizures discussing a total of 52 patients.…”

“…Schlick et al . [ 4 ] defined using meperidine 100 mg, 100–500 mg, >500 mg in adult in 24 h as low, medium, and high doses respectively. In their research, only two patients had reported seizure complications at low doses.…”