meperidine (Rx)

Moderate to severe pain

Adult: PO/SUBCUT/IM 50- 150 mg q3- 4 hr prn

Child: PO/SUBCUT/IM 1- 1.8 mg/kg q3- 4 hr prn, max single dose 150 mg Preoperatively

Adult: IM/SUBCUT 50- 100 mg 30- 90 min before surgery

Child: IM/SUBCUT 1- 2 mg/kg 30- 90 min before surgery, max 100 mg Renal dose

Adult: PO/SUBCUT/IM/IV, CCr 10- 50 ml/min give 75% of dose; CCr < 10 ml/min give 25% 50% of dose Labor analgesia

Adult: SUBCUT/IM 50- 100 mg given when contractions are regularly spaced, repeat q1- 3 hr prn

Available forms: Inj 10, 25, 50, 75, 100 mg/ml; tabs 50, 100 mg; syr 50 mg/5 ml

Implementation - Give with antiemetic if nausea, vomiting occur - Administer when pain is beginning to return; determine dosage interval by patient response; continuous dosing of medication is more effective given prn - Medication should be slowly withdrawn after long-term use to prevent withdrawal symptoms - Store in light-resistant container at room temperature PO route May be given with food or milk to lessen GI upset Syr should be mixed with 4 oz of water Oral liquid: dilute in 4 oz water IM/SUBCUT route Do not give if cloudy or a precipitate has formed Patient should remain recumbent for 1 hr after administration Inject IM into a large muscle mass; IM is preferred route for multiple injections Direct IV route Give after diluting to 10 mg/ml with sterile water, 0.9% NaCl for inj; give slowly at ≤ 25 mg/min; rapid administration may cause respiratory depression, hypotension, circulatory collapse Have emergency equipment and opiate antagonist on hand Continuous IV infusion route Give after diluting to 1 mg/ml with D₅W D₁₀W dextrose/saline combinations, dextrose/Ringer's, inj combinations, 0.45% NaCl, 0.9% NaCl, Ringer's, LR; give by inf pump; titrate according to response

Syringe compatibilities: Butorphanol, chlorproMAZINE, cimetidine, dimenhyDRINATE, diphenhydRAMEINE, droperidol, fentaNYL, glycopyrrolate, hydROXYzine, ketamine, metoclopramide, midazolam, pentazocine, perphenazine, prochlorperazine, promazine, ranitidine, scopolamine Syringe incompatibilities: Heparin, morphine, PENTobarbital

Y- site compatibilities: Amifostine, amikacin, atenolol, aztreonam, bumetanide, cefamandole, ceFAZolin, cefmetazole, cefotaxime, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cladribine, clindamycin, diltiazem, diphenhydRAMEINE, DOBUTamine, DOPamine, doxycycline, droperidol, erythromycin lactobionate, famotidine, filgrastim, fluconazole, fludarabine, gallium, gentamicin, granisetron, hydrocortisone, regular insulin, kanamycin, labetalol, lidocaine, melphalan, methylodopate, metoclopramide, metoprolol, metroNIDAZOLE, ondansetron, oxytocin, PACLITaxel, penicillin G potassium, piperacillin, potassium chloride, propofol, propranolol, ranitidine, sargramostim, teniposide, thiotepa, ticarcillin, ticarcillin/clavulanate, tobramycin, vancomycin, verapamil, vinorelbine Y- site incompatibilities: Cefoperazone, IDArubicin, imipenem/cilastatin, mezlocillin, minocycline Continuous intrathecal infusion route Use controlled- infusion device, an implantable controlled- microinfusion device is used for highly concentrated infusion, monitor for several days after implantation Infusion reservoir should only be filled by those fully qualified To prevent pain, depletion of reservoir should be avoided