Demerol--known generically as meperidine--is a narcotic indicated for relief of moderate to severe pain, according to Hospira, Inc., the drug's manufacturer. Demerol injections can be given into a vein or a muscle. Demerol has unique properties that cause adverse reactions not noted with similar medications. Although Demerol may be beneficial, there are several warnings related to its use. (Reference 2)
Delerium
As Demerol is metabolized by the body, a toxic byproduct called normeperidine is produced, explains an article by Susan M. Fosnight, RPH, CGP, BCPS and colleagues in the July 2004 Cleveland Clinic Journal Of Medicine. (Reference 2) This toxic byproduct of Demerol can cause delirium as it accumulates in the systems of elderly patients. (Reference 5) Signs of delirium are acute confusion, disorientation, poor memory, agitation, difficulty sleeping, hallucinations and extreme fear or anxiety. (Reference 1) The authors recommend use of alternate narcotic pain relievers that do not cause delirium. (Reference 5) Other patients at increased risk for these adverse reactions are those with decreased function of the kidneys, liver or thyroid gland, warns Hospira, Inc. (Reference 2)
Severe Interaction with Monoamine Oxidase Inhibitors
Demerol must not be taken by patients currently taking monoamine oxidase inhibitors, or MAOIs, nor within two weeks of taking these medicines. MAOIs are a group of antidepressants that includes Nardil, Parnate, Marplam and Emsam, the first antidepressant applied to the skin. According to Hospira, Inc., the combination of Demerol and MAOIs has resulted in severe and sometimes fatal reactions sometimes characterized by coma, suppression of breathing and low blood pressure, and at other times by convulsions, fever and high blood pressure. Deaths from these reactions have been reported . (Reference 2)
For Short-Term Use Only
Demerol should only be used for short-term relief of pain, according to the American Cancer Society. It is not recommended for long-term use, such as in managing cancer pain. In addition to delirium, the accumulation of the toxic byproduct of Demerol metabolism can cause other signs of toxicity in the central nervous system, including seizures, anxiety, tremors, twitching and myoclonus, a sudden and sometimes painful involuntary contraction of the muscles. (Reference 5) In addition, pain relief from Demerol does not last as long as relief from other similar medications such as morphine, making it less effective at providing ongoing pain relief. (Reference 3)
