Premium
Meperidine Is Alive and Well in the New Millennium: Evaluation of Meperidine Usage Patterns and Frequency of Adverse Drug Reactions
Author(s) -
Seifert Charles F.,
Kennedy Shalyn
Publication year - 2004
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.24.8.776.36066
Subject(s) - medicine , adverse effect , concomitant , dosing , cumulative dose , renal function , drug , anesthesia , pethidine , pharmacy , drug reaction , adverse drug reaction , pharmacology , family medicine , analgesic
Study Objectives. To report a classic case of normeperidine toxicity, and to present institution‐specific data on meperidine usage patterns and the frequency of adverse drug reactions (ADRs). Methods. A chart review was conducted of patients at high risk for ADRs. High‐risk patients were identified through the pharmacy computer system as those with renal insufficiency (creatinine clearance ≤ 50 ml/min), those receiving meperidine with patient‐controlled analgesia (PCA), or those receiving more than 200 mg/day of intravenous meperidine for multiple days. Results. Twenty‐five percent of patients who received meperidine had some degree of renal insufficiency. The average daily dose of meperidine was 230 mg; cumulative doses ranged from 10–7200 mg. Adverse drug reactions documented in 20 (14%) of 141 patients were confusion, anxiety, nervousness, hallucinations, twitching, and seizure. Sixteen of the 20 patients received meperidine by PCA pump or a combination of PCA and intravenous administration. Patients with ADRs to meperidine were older (58.5 vs 46.4 yrs, p=0.004), received more concomitant benzodiazepines (65.0% vs 4.1%, p<0.0001), and had a longer hospital stay (median 9.5 vs 4.6 days, p<0.001) than those who did not experience an ADR. A significant difference was found in cumulative PCA doses between patients with and without documented ADRs (median meperidine dose 863 and 455 mg, respectively, p=0.0157). Doses were directly correlated with both renal function (p<0.05) and length of stay (p<0.008). Dosing, duration, and frequency of ADRs for patients using PCA differed significantly between prescribing services (p<0.01). Conclusion. Patients using PCA meperidine are at particularly high risk of experiencing ADRs based on cumulative doses and duration of treatment. Adverse drug reactions were documented in approximately 14% of patients. Our results warrant restriction of PCA meperidine and evaluation of meperidine usage policies to improve pain management services and decrease the frequency of ADRs.