DEMEROL

 

DESCRIPTION / DEFINITIONS: Demerol is a brand name for Meperidine Hydrochloride, an opioid painkiller prescribed for moderate to severe pain. It is in the same class as other opioids including hydromorphone, fentanyl, tramadol, and more.

ABUSE: The potential for abuse with Demerol is high, even if taken as prescribed.

ADDICTION / DEPENDENCE: Because the risk of dependence and addiction is so high with Demerol, it is recommended only when other drugs or other pain solutions do not work and, even then, for the shortest period of time and at the lowest possible dose.

SIDE EFFECTS:  Demerol side effects range from nausea, vomiting, shortness of breath and stiff muscles to life-threatening conditions such as serotonin syndrome. See more complete information below.

WITHDRAWAL SYMPTOMS: Demerol withdrawal symptoms can include abdominal cramps, increased blood pressure and heart rate, muscle and joint pain, and more. See more complete list below.

TREATMENT: The safest and most comfortable way to quit Demerol is with a medically-supervised detox program. Call us to talk to a Detox Advisor.

DESCRIPTION / DEFINITIONS

Demerol is a brand name for Meperidine Hydrochloride. It is a narcotic (opioids) painkiller derived from morphine. It is approved for moderate or severe but acute and short-term pain, but its use is recommended only when no other solution, drug or otherwise, has brought relief.

Demerol should not be used for chronic pain because the longer you take it, the greater the risk of toxicity (which can result in symptoms like seizures) from the accumulation of the metabolite normeperidine. (See more in Half-Life and Metabolism.)

According to the label, Demerol is ‘an opioid pain medicine that can put you at risk for overdose and death’ – (even when taken as directed) which is why its use is supposed to be restricted to the lowest dosage possible and for the shortest period of time.

It is a schedule II drug – meaning it has a medical use but has a high potential for dependence, abuse and addiction – as do other drugs in this class, including hydromorphone, fentanyl, tramadol, and others.

The warning label for Demerol outlines the dangers of taking Demerol:

WARNING: RISK OF MEDICATION ERRORS; ADDICTION, ABUSE, AND MISUSE; LIFE-THREATENING RESPIRATORY DEPRESSION; ACCIDENTAL INGESTION; NEONATAL OPIOID WITHDRAWAL SYNDROME; CYTOCHROME P450 3A4 INTERACTION; RISKS FROM CONCOMITANT USE WITH BENZODIAZEPINES OR OTHER CNS DEPRESSANTS; AND MONOAMINE OXIDASE INHIBITORS (MAOIS) INTERACTIONS

See full prescribing information for complete boxed warning.

  • Ensure accuracy when prescribing, dispensing, and administering DEMEROL Oral Solution. Dosing errors due to confusion between mg and mL, and other Meperidine Hydrochloride Oral Solutions of different concentrations can result in accidental overdose and death.
  • DEMEROL®Tablets and Oral Solution expose users to risks of addiction, abuse, and misuse, which can lead to overdose and death. Assess patient’s risk before prescribing and monitor regularly for these behaviors and conditions.
  • Serious, life-threatening, or fatal respiratory depression may occur. Monitor closely, especially upon initiation or following a dose increase.
  • Accidental ingestion of DEMEROL®Tablets or Oral Solution, especially by children, can result in a fatal overdose of meperidine.
  • Prolonged use of DEMEROL®Tablets or Oral Solution during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated. If prolonged opioid use is required in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available.

  • Concomitant use with CYP3A4 inhibitors (or discontinuation of CYP3A4 inducers) can result in fatal overdose of meperidine.
  • Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing for use in patients for whom alternative treatment options are inadequate; limit dosages and durations to the minimum required; and follow patients for signs and symptoms of respiratory depression and sedation.
  • Concomitant use of DEMEROL®Tablets or Oral Solution with monoamine oxidase inhibitors (MAOIs) can result in coma, severe respiratory depression, cyanosis and hypotension. Use of DEMEROL® Tablets or Oral Solution with MAOIs within the last 14 days is contraindicated.


ABUSE

Abuse of Demerol is not unusual, and poses a risk of overdose and death. Demerol tablets are abused by crushing, chewing, snorting, or injecting the dissolved product.
The dangers of overdose and death are increased when taking Demerol while drinking alcohol or taking other CNS (central nervous system) depressants. CNS depressants are tranquilizers, sedatives, and hypnotics, which can slow brain activity.  They include:

  • Benzodiazepenes, such as diazepam (Valium®), clonazepam (Klonopin®), and alprazolam (Xanax®), triazolam (Halcion®), and estazolam (Prosom®)
  • Non-benzodiazepene sleep medications such as zolpidem (Ambien®), eszopiclone (Lunesta®), and zaleplon (Sonata®)
  • Barbiturates such as mephobarbital (Mebaral®), phenobarbital (Luminal®), and pentobarbital sodium (Nembutal®)

The majority of people who arrive at hospital emergency departments having overdosed on Demerol and similar drugs, have also been drinking or taking one or more of the above drugs, or something similar.

Other dangers of injecting crushed and prepared Demerol tablets is the presence of talc as a filler. The talc can cause local tissue necrosis (tissue death), infection, pulmonary granulomas (small areas of inflammation in the lungs), and increased risk of endocarditis (inflammation of the heart’s inner lining) and valvular heart disease damage to or a defect in one of the four heart valves).

Also, injecting Demerol and other drugs is commonly associated with transmission of infectious diseases such as hepatitis and HIV.

ADDiCTION / DEPENDENCE

One can become physically dependent on Demerol in a matter of just a few weeks.

One can also become psychologically addicted in the same period of time, or less.

As with other opiates and opioids, the risk of dependence and addiction gets higher the longer the drug is taken, and as the length of time it’s taken increases.

As you continue to take Demerol, the body builds a tolerance to the drug – which means the amount you’re taking is less able to bring pain relief. This prompts the individual to increase the dose and / or take it more frequently.

Taking more of the drug increases the risk of dependence, addiction, and overdose, as well as opening the door to more side effects, and make those you already have more severe.

HALF LIFE AND METABOLISM

The biological half-life of a substance is the time it takes for a drug to lose half of its pharmacologic activity. This is significant because it affects how soon withdrawal symptoms may appear.

The half life of Demerol is 3 to 8 hours (everyone’s metabolism is a little different), unless you’ve just had surgery, have liver problems, and possibly if you are otherwise unhealthy, in which case metabolizing Demerol can take twice as long.

Demerol is metabolized to normeperidine in the liver, mainly by the enzymes CYP34A and CYP2B6. Normeperidine is a toxic metabolite that, itself, has a half-life of 20.6 hours.

The CYP enzymes are the major enzymes involved in drug metabolism, and since many drugs may increase or decrease the activity of various CYP isozymes, this is a major source of adverse drug interactions, since changes in CYP enzyme activity may affect the metabolism and clearance of various drugs. For example, if one drug inhibits the CYP-mediated metabolism of another drug, the second drug may accumulate within the body to toxic levels, possibly causing an overdose.

OPIOID INDUCED HYPERALGESIA

Taking opioids like Demerol for longer than six months may create Opioid-Induced Hyperalgesia – a condition where the opioids actually make the pain receptors more sensitive and, therefore, make the pain greater. If you have this condition and take more of the drug to decrease the pain, the pain actually increases. Not knowing that the pain is being caused by the drug, you might then take more of the drug to try to get rid of the pain. Obviously, this can easily lead to overdose.

SIDE EFFECTS

The side effects of Demerol may be severe or life-threatening, and you should always be checked by your doctor to ensure the side effects you experience are not medically dangerous. Side effects associated with Demerol include:

  • abdominal pain
  • adrenal insufficiency – a potentially life-threatening condition that may be indicated if nausea, vomiting, anorexia, fatigue, weakness, dizziness, and low blood pressure occur
  • agitation
  • anaphylaxis – an acute allergic reaction that prompts the immune system to respond. The symptoms can include: fainting, lightheadedness, low blood pressure, dizziness, flushing, difficulty breathing, rapid breathing, shortness of breath,  wheezing, hives, swelling under the skin, blue skin from poor circulation, rashes, nausea,  vomiting, fast heart rate, feeling of impending doom, itching, tongue swelling, difficulty swallowing, facial swelling, mental confusion, nasal congestion, or impaired voice.
  • androgen deficiency – with chronic use, lower levels of male sex hormones, particularly testosterone, than is needed for health. This may cause hot flashes, sweating, insomnia, nervousness, irritability, tiredness, loss of motivation, short-term memory problems, declining self-esteem, depression, decreased energy levels, diminished muscle strength, decline or loss of libido or sexual desire, poor erections, reduced orgasmic quality, reduced volume of semen, diminished muscle mass, hair loss, abdominal obesity, reduction in high-density lipoprotein (HDL) cholesterol, an increase in total body fat, and osteoporosis
  • bradycardia – abnormally slow heart rate
  • cardiac arrest
  • chest pain
  • circulatory depression
  • confusion
  • constipation
  • delirium
  • diarrhea
  • disorientation
  • dizziness

  • dry mouth
  • extreme drowsiness
  • fast heartbeat
  • feeling like you might pass out
  • flushing of the face
  • headache
  • high body temperature
  • hypotension – low blood pressure, which can be severe
  • infertility, in men or women, may be permanent
  • involuntary muscle movements (e.g., muscle twitches, myoclonus)
  • lightheadedness
  • light-headedness when changing positions
  • loss of appetite
  • loss of coordination
  • miscellaneous skin rashes
  • mood changes (e.g., euphoria, dysphoria)
  • nausea
  • palpitation
  • Demerol passes from a pregnant mother to her unborn child, possibly causing the child to be addicted and go through withdrawal shortly after birth. Known as Neonatal Opioid Withdrawal Syndrome/
  • profound sedation, respiratory depression, coma, and death, especially when used with other opioids, with benzodiazepines, or with other CNS depressants (e.g., non-benzodiazepine sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, alcohol)
  • pruritus – itching
  • respiratory arrest
  • respiratory depression – serious, life-threatening, or fatal
  • sedation
  • seizures

  • serotonin syndrome – (when taken in combination with serotonergic drugs) – serotonin syndrome is a group of potentially life-threatening symptoms that include high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils, and diarrhea, associated with serotonergic drugs. Serotonergic drugs are used to treat migraine, depression, and other mood disorders.
  • severe convulsions
  • severe drowsiness
  • shivering
  • shock – a critical condition brought on by a sudden drop in blood flow through the body
  • shortness of breath
  • sleepiness
  • stiff muscles
  • sweating
  • swelling of your face, tongue, or throat
  • syncope – temporary loss of consciousness caused by a fall in blood pressure
  • tachycardia – abnormally fast heart rate
  • tiredness
  • hallucinations
  • tremors
  • trouble breathing
  • trouble walking
  • urinary retention
  • urticaria- a rash of very itchy round, red welts on the skin. It is sometimes accompanied by dangerous swelling and is generally an allergic reaction
  • visual disturbances
  • vomiting
  • weak or shallow breathing
  • weakness
  • wheal and flare reaction over the vein with intravenous injection

Overdose is a very real risk with Demerol, as with other opioids. Watch for the following overdose symptoms:

  • airway obstruction, partial or complete
  • bradycardia – very slow heart rate
  • cold and clammy skin
  • constricted pupils – pupils are smaller
  • hypotension – low blood pressure
  • marked mydriasis (dilation of the pupil of the eye ), rather than miosis ((excessive constriction of the pupil of the eye)) may be seen with hypoxia in overdose situations.
  • miosis – excessive constriction of the pupil of the eye, even in total darkness. (Note: Marked mydriasis (dilation of the pupil of the eye) rather than miosis may be seen due to hypoxia (deficiency in the amount of oxygen reaching the tissues)

  • pulmonary edema – excess fluid in the lungs, which makes it difficult to breathe
  • respiratory depression
  • skeletal muscle flaccidity
  • snoring – when the person doesn’t usually snore or unusual snoring
  • somnolence progressing to stupor or coma


WITHDRAWAL SYMPTOMS

Withdrawing from Demerol can be painful, uncomfortable and medically dangerous. Doctor supervision is always recommended. Demerol withdrawal symptoms include:

  • abdominal cramps
  • anorexia
  • anxiety
  • backache
  • chills
  • diarrhea
  • increased blood pressure
  • increased heart rate
  • increased respiratory rate
  • insomnia
  • irritability
  • joint pain

  • lacrimation – shedding tears, more than usual, like you have something in your eye
  • myalgia – pain in a muscle or group of muscles
  • mydriasis – dilation of the pupil of the eye
  • nausea
  • perspiration
  • restlessness
  • rhinorrhea – runny nose
  • vomiting
  • weakness
  • yawning

Note: If a breast-feeding mother uses Demerol, the baby can experience side effects of excessive sedation and respiratory depression. The baby can also experience withdrawal symptoms when the mother stops taking Demerol or stops breastfeeding.

TREATMENT

Withdrawing from Demerol should be done under medical supervision. The best treatment protocol is in a medical detox facility that can assist make sure the withdrawal is safe and more comfortable. Call us to talk to a Detox Advisor.