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Suitable extinguishing media: Use water spray, alcohol-resistant foam, dry chemical or carbon dioxide. /Meperidine hydrochloride/

Advice for firefighters: Wear self contained breathing apparatus for fire fighting if necessary. /Meperidine hydrochloride/

Keep container tightly closed in a dry and well-ventilated place. /Meperidine hydrochloride/

Meperidine hydrochloride preparations should be protected from light and stored at a temperature less than 40 °C; meperidine hydrochloride tablets should be stored at 15-30 °C and meperidine hydrochloride injections should be stored at 15-25 °C. Freezing of meperidine hydrochloride oral solutions or injections should be avoided. Meperidine hydrochloride oral solutions or tablets should be stored in tight or well-closed containers, respectively.

Store in a tightly sealed container, protected from light, and at room temperature. It is soluble in water. It may be mixed with 0.9% saline or 5% dextrose for 28 days without loss of potency or stability. It is stable in syrup formation. Protect from freezing.

ACCIDENTAL RELEASE MEASURES: Personal precautions, protective equipment and emergency procedures: Wear respiratory protection. Avoid dust formation. Avoid breathing vapors, mist or gas. Ensure adequate ventilation. Evacuate personnel to safe areas. Avoid breathing dust. Environmental precautions: Prevent further leakage or spillage if safe to do so. Do not let product enter drains. Methods and materials for containment and cleaning up: Pick up and arrange disposal without creating dust. Sweep up and shovel. Keep in suitable, closed containers for disposal. /Meperidine hydrochloride/

SRP: Expired or waste pharmaceuticals shall carefully take into consideration applicable DEA, EPA, and FDA regulations. It is not appropriate to dispose by flushing the pharmaceutical down the toilet or discarding to trash. If possible return the pharmaceutical to the manufacturer for proper disposal being careful to properly label and securely package the material. Alternatively, the waste pharmaceutical shall be labeled, securely packaged and transported by a state licensed medical waste contractor to dispose by burial in a licensed hazardous or toxic waste landfill or incinerator.

Product: Offer surplus and non-recyclable solutions to a licensed disposal company. Contact a licensed professional waste disposal service to dispose of this material. Dissolve or mix the material with a combustible solvent and burn in a chemical incinerator equipped with an afterburner and scrubber; Contaminated packaging: Dispose of as unused product. /Meperidine hydrochloride/

ACCIDENTAL RELEASE MEASURES: Personal precautions, protective equipment and emergency procedures: Wear respiratory protection. Avoid dust formation. Avoid breathing vapors, mist or gas. Ensure adequate ventilation. Evacuate personnel to safe areas. Avoid breathing dust. Environmental precautions: Prevent further leakage or spillage if safe to do so. Do not let product enter drains. /Meperidine hydrochloride/

Precautions for safe handling: Avoid contact with skin and eyes. Avoid formation of dust and aerosols. Provide appropriate exhaust ventilation at places where dust is formed. Normal measures for preventive fire protection. /Meperidine hydrochloride/

Appropriate engineering controls: Avoid contact with skin, eyes and clothing. Wash hands before breaks and immediately after handling the product. /Meperidine hydrochloride/

Gloves must be inspected prior to use. Use proper glove removal technique (without touching glove's outer surface) to avoid skin contact with this product. Dispose of contaminated gloves after use in accordance with applicable laws and good laboratory practices. Wash and dry hands. /Meperidine hydrochloride/

SRP: Local exhaust ventilation should be applied wherever there is an incidence of point source emissions or dispersion of regulated contaminants in the work area. Ventilation control of the contaminant as close to its point of generation is both the most economical and safest method to minimize personnel exposure to airborne contaminants. Ensure that the local ventilation moves the contaminant away from the worker.

Eye/face protection: Face shield and safety glasses. Use equipment for eye protection tested and approved under appropriate government standards such as NIOSH (US) or EN 166(EU). /Meperidine hydrochloride/

Skin protection: Handle with gloves. /Meperidine hydrochloride/

Body Protection: Complete suit protecting against chemicals. The type of protective equipment must be selected according to the concentration and amount of the dangerous substance at the specific workplace. /Meperidine hydrochloride/

Respiratory protection: Where risk assessment shows air-purifying respirators are appropriate use a full-face particle respirator type N99 (US) or type P2 (EN 143) respirator cartridges as a backup to engineering controls. If the respirator is the sole means of protection, use a full-face supplied air respirator. Use respirators and components tested and approved under appropriate government standards such as NIOSH (US) or CEN (EU). /Meperidine hydrochloride/

Primary attention should be given to the reestablishment of adequate respiratory exchange through provision of a patent airway and institution of assisted or controlled ventilation. The narcotic antagonist, naloxone hydrochloride, is a specific antidote against respiratory depression which may result from overdosage or unusual sensitivity to narcotics, including meperidine. Therefore, an appropriate dose of this antagonist should be administered, preferably by the intravenous route, simultaneously with efforts at respiratory resuscitation. An antagonist should not be administered in the absence of clinically significant respiratory or cardiovascular depression. Oxygen, intravenous fluids, vasopressors, and other supportive measures should be employed as indicated. In cases of overdosage with Meperidine tablets, the stomach should be evacuated by emesis or gastric lavage. (L1712)

Table: Clinically Significant Drug Interactions with Meperidine Hydrochloride Tablets and Oral Solutionhttps://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=15bc51a8-1e24-4d33-9a2f-05a41c29acf0 [Table#4451]

Since virtually all the reported incidents of opiate agonist interaction with monoamine oxidase (MAO) inhibitors have occurred in patients receiving meperidine, meperidine is contraindicated in patients who are receiving these drugs or have received these drugs during the previous 14 days. In some patients receiving MAO inhibitors, therapeutic doses of meperidine have produced coma, severe respiratory depression, cyanosis, and hypotension resembling the typical syndrome of acute opiate agonist overdosage. Although the mechanism for this interaction has not been elucidated, it has been suggested that these adverse effects may be associated with preexisting hyperphenylalaninemia. In other patients on MAO inhibitor therapy, meperidine has caused hyperexcitability, seizures, tachycardia, pyrexia, and hypertension. IV hydrocortisone or prednisolone has been used to treat severe reactions, with the addition of IV chlorpromazine hydrochloride in patients exhibiting hypertension and hyperpyrexia. The usefulness and safety of opiate antagonists in the treatment of these reactions are unknown.

Serotonin syndrome has occurred in patients receiving opiate agonists, including meperidine, in conjunction with other serotonergic drugs, including serotonin (5-hydroxytryptamine; 5-HT) type 1 receptor agonists ("triptans"), selective serotonin-reuptake inhibitors (SSRIs), selective serotonin- and norepinephrine-reuptake inhibitors (SNRIs), tricyclic antidepressants, antiemetics that are 5-HT3 receptor antagonists, buspirone, cyclobenzaprine, dextromethorphan, lithium, St. John's wort (Hypericum perforatum), tryptophan, other serotonin modulators (e.g., mirtazapine, nefazodone, trazodone, vilazodone), and MAO inhibitors (both those used to treat psychiatric disorders and others, such as linezolid, methylene blue, and selegiline). Serotonin syndrome may occur within the recommended dosage ranges for these drugs. Manifestations of serotonin syndrome may include mental status changes (e.g., agitation, hallucinations, coma), autonomic instability (e.g., tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination, rigidity), and/or GI symptoms (e.g., nausea, vomiting, diarrhea). Symptom onset generally occurs within several hours to a few days of concomitant use, but may occur later, particularly after dosage increases. Meperidine should not be used concomitantly with other serotonergic agents; use of meperidine in patients who are receiving or have recently (within 14 days) received an MAO inhibitor is contraindicated. ... If serotonin syndrome is suspected, treatment with meperidine, other opiate therapy, and/or any concurrently administered serotonergic agents should be discontinued

Administration of meperidine to patients on isoniazid therapy has been reported to aggravate the adverse effects of isoniazid.

For more Interactions (Complete) data for Meperidine (30 total), please visit the HSDB record page.

TERRESTRIAL FATE: Based on a classification scheme(1), an estimated Koc value of 1560(SRC), determined from a structure estimation method(2), indicates that meperidine is expected to have low mobility in soil(SRC). The pKa of meperidine is 8.68(3), indicating that this compound will exist almost entirely in cation form in the environment and cations generally adsorb more strongly to soils containing organic carbon and clay than their neutral counterparts(4). Volatilization of the cation from moist soil is not expected because cations do not volatilize(SRC). Meperidine is not expected to volatilize from dry soil surfaces(SRC) based upon an estimated vapor pressure of 8.4X10-7 mm Hg at 25 °C(SRC), determined from a fragment constant method(2). Biodegradation data in soil were not available(SRC, 2017).

AQUATIC FATE: Based on a classification scheme(1), an estimated Koc value of 1560(SRC), determined from a structure estimation method(2), indicates that meperidine is expected to adsorb to suspended solids and sediment(SRC). A pKa of 8.68(3) indicates meperidine will exist almost entirely in the cation form at pH values of 5 to 9 and, therefore, volatilization from water surfaces is not expected to be an important fate process(SRC). Meperidine is not expected to undergo hydrolysis in the environment based on estimated hydrolysis half-lives of 820 and 82 years at respective pH values of 7 and 8(2). According to a classification scheme(4), an estimated BCF of 30(SRC), from its log Kow of 2.72(5) and a regression-derived equation(2), suggests the potential for bioconcentration in aquatic organisms is moderate. Biodegradation data in water were not available(SRC, 2017).

ATMOSPHERIC FATE: According to a model of gas/particle partitioning of semivolatile organic compounds in the atmosphere(1), meperidine, which has an estimated vapor pressure of 8.4X10-7 mm Hg at 25 °C(SRC), determined from a fragment constant method(2), will exist in both the vapor and particulate phases in the ambient atmosphere. Vapor-phase meperidine is degraded in the atmosphere by reaction with photochemically-produced hydroxyl radicals(SRC); the half-life for this reaction in air is estimated to be 4 hours(SRC), calculated from its rate constant of 9.7X10-11 cu cm/molecule-sec at 25 °C(SRC) that was derived using a structure estimation method(2). Particulate-phase meperidine may be removed from the air by wet or dry deposition(SRC). Meperidine does not contain chromophores that absorb at wavelengths >290 nm(3) and, therefore, is not expected to be susceptible to direct photolysis by sunlight(SRC).

Intravenous; oral; parenteral (intramuscular). The oral bioavailability of meperidine in patients with normal hepatic function is 50-60% due to extensive first-pass metabolism. Bioavailability increases to 80-90% in patients with hepatic impairment (e.g. liver cirrhosis). Meperidine is less than half as effective when administered orally compared to parenteral administration. One study reported that 80-85% of the drug administered intramuscularly was absorbed within 6 hours of intragluteal injection in health adults; however, inter-individual variation and patient-specific variable appear to cause considerable variations in absorption upon IM injection.

IDENTIFICATION AND USE: Meperidine is a solid. Meperidine is a strong analgesic used in the relief of moderate to severe pain. The drug has been used to relieve the pain of myocardial infarction. Meperidine also is used parenterally for preoperative sedation, as a supplement to anesthesia, and to provide analgesia during labor. HUMAN STUDIES: Meperidine is a mu- and kappa-opiate receptor agonist with approximately 20-25% the potency of morphine. Receptors for opiate analgesics are found in high concentrations in the limbic system, spinal cord, thalamus, hypothalamus, striatum, and midbrain. They are also found in tissues such as the gastrointestinal tract, urinary track, and in other smooth muscle. Meperidine is different from other opioids because its active metabolite, normeperidine, is neurotoxic. The lethal meperidine blood concentration is 1-3 mg/dL. Common side effects include nausea, vomiting and hypotension. Meperidine can produce further hypotension in patients who have blood loss due to trauma. In high doses, it has been associated with seizure. Obstetric analgesia in the form of meperidine to mothers during delivery has adverse effects on some aspects of the behavior of their newborn infants. ANIMAL STUDIES: In mice a reversible opacity of the front of the lens has been observed to develop acutely after systematic administration of meperidine, because of reduced blinking, exposing the eye to evaporation and causing dehydration of the lens. Meperidine is reported to inhibit the release of gonadotropins in animals. Prolonged administration of up to 6 times the recommended therapeutic dose to dogs produces slight anorexia and loss of weight. Doses of 100 mg or more produce excitement and clonic convulsions, which can be controlled by barbiturates, in cats. Following an im dose of 10 mg/kg meperidine, reduction in heart rate and drop in the systemic arterial pressure occur in dogs. Generally, the fall in blood pressure is moderate, and occurs 10-20 minutes after im injection, with return to control level in 30 minutes. Subcutaneous doses in excess of 20-30 mg/kg meperidine can produce excitement and clonic convulsions in cats. The chronic epidural administration of pethidine in rabbits induces moderate to severe histological changes on the spinal cord.

Meperidine is a potent opioid analgesic that has the potential for habit-forming and misuse, which increases the risk of overdose. Overdose of meperidine happens in:

Meperidine is primarily a kappa-opiate receptor agonist and also has local anesthetic effects. Meperidine has more affinity for the kappa-receptor than morphine. Opiate receptors are coupled with G-protein receptors and function as both positive and negative regulators of synaptic transmission via G-proteins that activate effector proteins. Binding of the opiate stimulates the exchange of GTP for GDP on the G-protein complex. As the effector system is adenylate cyclase and cAMP located at the inner surface of the plasma membrane, opioids decrease intracellular cAMP by inhibiting adenylate cyclase. Subsequently, the release of nociceptive neurotransmitters such as substance P, GABA, dopamine, acetylcholine and noradrenaline is inhibited. Opioids also inhibit the release of vasopressin, somatostatin, insulin and glucagon. Opioids close N-type voltage-operated calcium channels (OP2-receptor agonist) and open calcium-dependent inwardly rectifying potassium channels (OP3 and OP1 receptor agonist). This results in hyperpolarization and reduced neuronal excitability.

Meperidine was detected, not quantified, in effluent of one wastewater treatment plant (WWTP) from New York that receives effluent from a pharmaceutical formulation facility (PFF) in samples collected 2004 to 2009; it was not detected in effluent of another WWTP that receives effluent from another PFF or in the effluent of 24 other WWTPs from around the country(1).

Using a structure estimation method based on molecular connectivity indices(1), the Koc of meperidine can be estimated to be 1560(SRC). According to a classification scheme(2), this estimated Koc value suggests that meperidine is expected to have low mobility in soil. The pKa of meperidine is 8.68(3), indicating that this compound will exist almost entirely in the cation form in the environment and cations generally adsorb more strongly to soils containing organic carbon and clay than their neutral counterparts(4).

Schedule II shall consist of the drugs and other substances, by whatever official name, common or usual name, chemical name, or brand name designated, listed in this section. Each drug or substance has been assigned the DEA Controlled Substances Code Number set forth opposite it. ... Opiates. Unless specifically excepted or unless in another schedule any of the following opiates, including its isomers, esters, ethers, salts and salts of isomers, esters and ethers whenever the existence of such isomers, esters, ethers, and salts is possible within the specific chemical designation, dextrorphan and levopropoxyphene excepted: Pethidine (meperidine) (DEA Code Number: 9230) is included on this list.

The Approved Drug Products with Therapeutic Equivalence Evaluations identifies currently marketed prescription drug products, including meperidine hydrochloride, approved on the basis of safety and effectiveness by FDA under sections 505 of the Federal Food, Drug, and Cosmetic Act. /Meperidine hydrochloride/

Pethidine (meperidine) (DEA Code Number: 9230) is a Schedule II controlled substance.

Schedule II Controlled Substance: (A) The drug or other substance has a high potential for abuse; (B) The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions; and (C) Abuse of the drug or other substances may lead to severe psychological or physical dependence.

Analgesics, Opioid; Adjuvants, Anesthesia; Narcotics

MEDICATION (VET)

MEDICATION

Use (kg; approx.) in Germany (2009): >100

Pethidine, predominantly a mu-receptor agonist, is a phenyl-piperidinic synthetic drug. It is used in the management of moderate to several pain. A possible hydrolytic degradation of an ester group can generate a very toxic compound, the N-methyl-4-phenyl-1,2,3,6 tetrahydropyridine (MPTP) which contaminates the drug. ...

Preperation: Eisleb, United States of America patent 2167351 (1939 to Winthrop).

Methyldiethanolamine + benzyl chloride + ethanol (alcohol chlorination/dehydrochlorination/nitrile hydrolysis/esterification)

Isonipecaine hydrochloride; pethidine hydrochloride

Table: Dextromethorphan Hydrochloride Preparations [Table#4450]

Trade names for meperidine include DEMEROL and PETHADOL. The international nonproprietary name is pethidine. Meperidine hydrochloride is available for oral use in tablets (50 and 100 mg) and as a syrup, and in solutions for parenteral use.

Algil, Alodan, Centralgin, Demerol hydrochloride, Dispadol, Dolantin, Dolestine, Dolosal, Mefedina. /Meperidine hydrochloride/

Meperidine (Demerol), promethazine (Phenergan), and chlorpromazine (Thorazine), also known as "DPT" or "pedi cocktail", is a popular sedative combination administered as a single injection.