meperidine
Demerol (meperidine) is an opioid medication that's typically used for pain when other treatment options haven't worked well. Your provider will work with you closely to find a safe dosage that can help relieve your pain. It shouldn't be used long term because of its serious risks and side effects, such as withdrawal if you stop the medication suddenly. Demerol (meperidine) is available as generic pill and liquid, as well as a brand-name and generic injection.
What is Demerol (meperidine)?
What is Demerol (meperidine) used for?
Pain that isn't relieved by alternative treatments (e.g., non-opioid pain medications) alone
How Demerol (meperidine) works
Demerol (meperidine) is an opioid. It works by attaching to certain proteins in your brain to change how you perceive pain. It helps lower how much pain you feel.
Drug Facts
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What are the risks and warnings for Demerol (meperidine)?
Demerol (meperidine) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Dangerously slow breathing (respiratory depression)
Risk factors: Taking medications that can cause slow breathing | Drinking alcohol | Older age | Being frail | Medical conditions that cause breathing problems (e.g., COPD, asthma, head injury) | Taking too much Demerol (meperidine)
Demerol (meperidine) can cause dangerously slow breathing, which can be life-threatening. This can happen to anyone and at any time. But the risk is highest when you first start treatment or when your dose goes up. Don't take Demerol (meperidine) with alcohol or other medications that slow your body down (e.g., benzodiazepines, other opioids, muscle relaxants). Doing so raises your risk of extremely slowed breathing.
Discuss with your provider about getting naloxone (Narcan) if you're concerned with the risk of overdosing with Demerol (meperidine). Naloxone can help reverse the effects of opioids and possibly save your life. Call 911 or get medical help right away if you or your loved ones notice that you have trouble breathing or have bluish-colored lips, fingers, or toes.
Potential for addiction and misuse
Risk factors: Personal or family history of alcohol or substance use disorder | Personal or family history of mental health conditions
Demerol (meperidine) is a controlled substance that has a risk for addiction and misuse. Misusing this medication might cause it to not work as well. It can also raise the risk for serious and possibly life-threatening side effects, such as dangerously slow breathing, extreme sleepiness, and opioid overdose.
Because of these risks, the FDA has required Demerol (meperidine) and all opioids to be under a Risk Evaluation and Mitigation Strategy (REMS) program. This means your provider or pharmacist will talk to you about proper use, serious risks, and appropriate storage and disposal of this medication to keep you and your loved ones safe.
Take Demerol (meperidine) exactly as prescribed to lower your risk of addiction and misuse. Don't change the dose or how often you take it without talking to your provider first. Your healthcare provider will prescribe the lowest amount of Demerol (meperidine) that's necessary to manage your pain for the shortest period of time possible.
Risk of opioid overdose
Risk factors: History of opioid use disorder | Previous opioid overdose | Taking high doses of Demerol (meperidine) | Taking more opioids than prescribed | Alcohol use
Take Demerol (meperidine) exactly as prescribed. Taking too much Demerol (meperidine) or taking it more often than prescribed can lead to an overdose. Symptoms of an opioid overdose include not responding to sound or touch, extremely slowed breathing, extreme sleepiness, slow heartbeat, and cold or clammy skin.
Be sure you and your loved ones know how to recognize an overdose. Your provider will probably recommend naloxone (Narcan), an opioid antagonist that can treat an opioid overdose. Make sure you carry naloxone with you at all times in case you experience an overdose. Call 911 right away if this happens. Store your medication out of reach from children, pets, or visitors to prevent accidental exposure or overdose.
Dangerous interactions with other medications and alcohol
Demerol (meperidine) can interact with other medications, which can change how it affects your body and pain overall. Some medications can raise the amount of Demerol (meperidine) in your body and cause fatal respiratory depression (slowed breathing). Others can lower the amount of Demerol (meperidine) and lead to poor control of your pain.
Some examples of medications that might interact with Demerol (meperidine) include certain antibiotics, antifungals, and medications used for anxiety or depression. If you're already taking stable doses of Demerol (meperidine) together with one of these other medications, don't stop taking them suddenly. Doing so can also lead to unsafe Demerol (meperidine) levels.
Let your provider or pharmacist know what other medications you take or plan to take to make sure they're safe to take with Demerol (meperidine). Also avoid drinking alcohol while you're taking Demerol (meperidine) because this combination can lead to serious side effects, such as slowed breathing, extreme sedation, and low blood pressure.
Harm to newborn babies
Risk factors: Long-term use of Demerol (meperidine) during pregnancy
There's a high risk that your newborn baby could develop withdrawal symptoms if you've been using Demerol (meperidine) for a long time during pregnancy. This condition is called neonatal opioid withdrawal syndrome and can be life-threatening if not recognized and treated in time. If you're pregnant or think you might be pregnant, talk to your provider about all the risks that come with taking this medication.
Higher sensitivity to pain
Rarely, Demerol (meperidine) can cause you to be more sensitive to pain or have a higher amount of pain. Never try to raise your dose of Demerol (meperidine) without talking to your provider, since this could lead to a life-threatening overdose. Contact your healthcare provider if you're having more pain, feel more sensitive to pain, or feel pain from things that usually don't cause you pain.
Serotonin syndrome
Risk factors: Taking other medications that raise serotonin levels in your brain
Serotonin syndrome is a rare, but life-threatening condition caused by very high levels of serotonin in the brain. Your risk goes up if you use Demerol (meperidine) with other medications that affect serotonin (such as antidepressants, certain migraine medications, and St. John's wort). Symptoms of serotonin syndrome include fast heart rate, sweating, muscle stiffness or spasms, fever, and confusion. Get medical attention right away if you notice any of these symptoms.
Low adrenal hormone levels
Risk factors: Taking Demerol (meperidine) for longer than 1 month
Some people taking opioids like Demerol (meperidine) experienced low adrenal hormone levels. This might be more likely to happen after taking opioids for longer than 1 month. Symptoms include tiredness, weakness, not feeling hungry, nausea, and vomiting. Tell your provider if you experience these symptoms. If your adrenal hormone levels are too low, you might need to stop Demerol (meperidine) and get treated with corticosteroids.
Low blood pressure
Demerol (meperidine) can cause extremely low blood pressure. A drop in blood pressure can happen when you stand from a sitting or lying down position. This can lead to dizziness and fainting. To avoid falling, get up slowly if you've been sitting or lying down. Talk to your healthcare provider if the dizziness or lightheadedness doesn't go away.
Physical dependence and withdrawal
Risk factors: Long-term use of Demerol (meperidine)
If taken regularly for a long time, Demerol (meperidine) can cause physical dependence. This means that your body relies on the medication to function. And you might experience withdrawal if you stop taking the medication suddenly. Withdrawal symptoms include anxiety, restlessness, irritability, runny nose, yawning, sweating, chills, and body aches. Don't lower your dose or stop taking the medication suddenly without talking to your healthcare provider first. To prevent withdrawal, your provider will lower your dose little by little until you can stop the medication safely. Talk to your healthcare provider about alternative pain medications if you have concerns about taking Demerol (meperidine) because of this risk.
Difficulty concentrating and extreme sleepiness
Risk factors: Age 65 years or older | Drinking alcohol | Taking other medications that can cause sleepiness
Demerol (meperidine) can cause extreme sleepiness and lower your ability to think, react, and focus. Don't mix Demerol (meperidine) with alcohol or take other medications that can cause sleepiness or "brain fog" (e.g., benzodiazepines, muscle relaxants, sleep medications). Doing so can worsen these side effects. Make sure you know how Demerol (meperidine) affects you before driving a car or doing activities that require your concentration. Talk to your healthcare provider right away if you feel too sleepy from taking Demerol (meperidine).
Caution use in people with seizure or heart rhythm problems
Risk factors: History of seizures | History of heart problems | Long-term use of Demerol (meperidine)
People who have a history of seizures are at higher risk of having seizures while they're taking Demerol (meperidine). In addition, people who have certain heart rhythm conditions (arrhythmias) can develop a fast heartbeat while taking this medication. Talk to your provider about your full medical history before you start this medication.
Not for use in people with a gastrointestinal (GI) blockage
Don't use Demerol (meperidine) if you have certain stomach conditions or GI blockage because it can worsen your problems. Let your provider know if you experience stomach pain, feeling of fullness in your stomach, or extreme constipation while taking this medication. They'll examine your digestive tract to see what the problem might be.
What are the side effects of Demerol (meperidine)?
Common Side Effects
- Lightheadedness
- Dizziness
- Sleepiness
- Nausea
- Vomiting
- Sweating
Other Side Effects
- Weakness
- Headache
- Tremor
- Confusion
- Dry mouth
- Constipation
- Low blood pressure
- Rash
Serious Side Effects
- Allergic reaction: trouble breathing; hives; swelling in your face, lips, tongue, or throat
- Dangerously slow breathing: trouble breathing; bluish-colored lips, fingers, or toes
- Extremely low blood pressure: dizziness, lightheadedness, fainting
- Accidentally taking too much (overdose): not responding to sound or touch, slowed breathing, extreme sleepiness, slow heartbeat, cold or clammy skin
- Opioid withdrawal: anxiety, irritability, suicidal thoughts, restlessness, runny nose, yawning, sweating, chills, wide pupils, body aches, uncontrolled pain
- Serotonin syndrome: fast heart rate, dizziness, sweating, flushing, shakiness, muscle stiffness, muscle twitching, uncoordinated movement, seizures, hallucinations
- Seizures
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- CNS depression—slow or shallow breathing, shortness of breath, feeling faint, dizziness, confusion, trouble staying awake
- Low adrenal gland function—nausea, vomiting, loss of appetite, unusual weakness or fatigue, dizziness
- Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Constipation
- Dizziness
- Drowsiness
- Dry mouth
- Headache
- Nausea
- Vomiting
Pros and cons of Demerol (meperidine)
Pros
Possible option when other pain medications haven't worked well
Works fairly quickly to relieve pain
Available as a lower-cost generic medication
Available as a liquid if you're not able to take pills
Cons
Not a first-choice option used to treat pain
Can be habit-forming
Not meant for long-term pain relief
Can't use if you're currently taking, or have taken in the last 14 days, certain medications called monoamine oxidase inhibitors (MAOIs)
Pharmacist tips for Demerol (meperidine)
Talk to your provider or pharmacist before starting a new prescription or over-the-counter medication to avoid dangerous interactions with Demerol (meperidine). Some drug interactions with Demerol (meperidine) can cause life-threatening breathing problems.
Don't drink alcohol or consume products that contain alcohol while you're taking Demerol (meperidine). Mixing alcohol with Demerol (meperidine) can put you at risk for low blood pressure, breathing problems, extreme sedation, and getting into accidents.
Demerol (meperidine) can cause drowsiness and dizziness. Avoid driving and doing activities that require you to be alert until you know how Demerol (meperidine) affects you.
For the liquid formulation of Demerol (meperidine): Make sure you use a marked measuring spoon, oral syringe, or medication cup that's provided by your provider or pharmacist to measure out the medication. Don't use a household spoon because you might not get the correct dose and lead to poor pain relief or an accidental overdose.
If you've been taking Demerol (meperidine) long-term, don't stop taking it suddenly. Your provider might need to help you adjust your dose so you can safely stop this medication to avoid withdrawal symptoms. Typically, this means cutting back on your dose gradually over the course of a few days or weeks. Make sure to follow your provider's instructions to lower the dose or stop the medication safely.
Talk to your provider about the risks and benefits of this medication if you're pregnant or breastfeeding, since Demerol (meperidine) can cause harm to babies.
Store Demerol (meperidine) in a safe place away from other people and especially children. This helps prevent misuse and overdose from accidental exposure.
Frequently asked questions about Demerol (meperidine)
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Demerol (meperidine) dosage forms
Typical dosing for Demerol (meperidine)
Your provider will work with you to prescribe the right dose of Demerol (meperidine) for your individual needs. It's recommended to use the lowest dose possible for the shortest duration of time to manage your pain.
Adults: In general, the typical starting dose is 50 mg to 150 mg by mouth every 3 or 4 hours as needed for pain.
Children: The dose is based on your child's body weight. In general, the typical starting dose is 1.1 mg/kg to 1.8 mg/kg of body weight by mouth, up to the adult dose, every 3 or 4 hours as needed for pain.
How much does Demerol (meperidine) cost?
Demerol (meperidine) contraindications
Severe breathing problems
Sudden or severe asthma
Taking monoamine oxidase inhibitors (MAOIs) at the same time as Demerol (meperidine) or taking Demerol (meperidine) within 14 days of having taken an MAOI
Known or suspected stomach or intestinal blockage
What is the latest news about Demerol (meperidine)?
Demerol (meperidine) images
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References
Best studies we foundAlfonsi, P., et al. (1998). The effects of meperidine and sufentanil on the shivering threshold in postoperative patients. Anesthesiology.
Buck, M. L. (2011). Is meperidine the drug that just won't die? The Journal of Pediatric Pharmacology and Therapeutics.
Centers for Disease Control and Prevention. (2020). Spoons are for soup, milliliters are for medicine.
Centers for Disease Control and Prevention. (2022). About opioid use during pregnancy.
Department of Justice/Drug Enforcement Administration. (2020). Narcotics.
Dowell, D., et al. (2022). CDC clinical practice guideline for prescribing opioids for pain — United States, 2022. Morbidity and Mortality Weekly Report.
Friesen, K. J., et al. (2016). The safety of meperidine prescribing in older adults: A longitudinal population-based study. BioMed Central Geriatrics.
Hikma Pharmaceuticals USA Inc. (2023). Meperidine hydrochloride tablet; solution [package insert]. DailyMed.
Jansson, L. M., et al. (2019). Neonatal abstinence syndrome. Pediatric Clinics of North America.
Lopez, M. B. (2018). Postanaesthetic shivering - From pathophysiology to prevention. Romanian Journal of Anaesthesia and Intensive Care.
National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Symptoms & causes of adrenal insufficiency & Addison's disease.
National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Adrenal insufficiency & Addison’s disease.
Opioid Analgesic REMS. (2023). Risk evaluation and mitigation strategy.
U.S. Department of Health and Human Services. (n.d.). Preventing an opioid overdose.
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