Demerol

What is the deal with Demerol and why it simply has to go…

Demerol also called meperidine hydrochloride works like any other opioid analgesic in that it binds with opiate receptors in the spinal cord and in the brain to alter the perception and response to pain. Demerol is commonly used during childbirth and it is frequently used for people experiencing chronic pain. People who are allergic to Morphine may also receive Demerol in hospital for treatment of their agony and suffering.

Get to the bad news
Demerol can be given either by mouth (PO) or parenterally via the subcutaenous (SC) or intramuscular (IM) route. New research indicates that IM injections are contraindicated. Studies have shown that not only is this route painful, the absorption of medications given through the IM route is unpredictable and therefore hard to control. We still see a large number of pain control orders of IM Demerol. SC Demerol is not recommended because Demerol is very irritating to the surrounding tissues and causes pain (and infrequently a local cellulitis). Demerol is rarely given orally because this route is less than half effective as a parenteral Demerol, so the dosage required must be considerably higher.

I don’t care, this node is boring

Demerol undergoes first pass through the liver. Meperidine is broken down and its metabolites are called normeperidine. These are toxic, and can cause signficant liver and kidney damage.

We can’t predict the absorption rates with the IM route, we can’t give this drug PO because we’ll raise toxic metabolite concentrations, and we don’t give this drug SC because it is not recommended.