What Is Demerol - Injection?
Demerol (meperidine) is in a class of medications called opioid analgesics. It is most commonly used in a hospital setting with anesthesia before surgery to help relieve severe, short-lasting pain.
Demerol works by blocking opioid receptors in the brain. As a result, the brain replaces the feeling of pain with the “feel good” effects of the medication.
Although effective, this medication is not used as a first option to help with severe pain due to the high risks of adverse effects and dependency or misuse. It is generally used when alternative options are inadequate.
This medication is available as an intramuscular (into the muscle), subcutaneous (under the skin), and intravenous (into the vein) injection. A trained healthcare provider will give you meperidine in a hospital or clinic.
Drug Facts
Generic Name: Meperidine
Brand Name(s): Demerol
Drug Availability: Prescription
Administration Route: Intramuscular, subcutaneous, intravenous
Therapeutic Classification: Opioid analgesic
Available Generically: Yes
Controlled Substance: Yes, Schedule II
Active Ingredient: Meperidine hydrochloride
Dosage Form(s): Solution for injection
What Is Demerol Used For?
The Food and Drug Administration (FDA) approved Demerol for use with anesthesia before surgery to help relieve severe, short-term pain. It is not used for chronic (long-lasting) pain.
Meperidine is considered a controlled substance due to the risks of drug misuse and dependency, even at recommended doses. Healthcare providers generally reserve controlled substance use when other treatment options are inadequate at providing pain relief or not tolerated well.
How to Take Demerol
A trained healthcare provider will typically give you the injection. You will be lying down while they give you the injection.
If you need to continue therapy at home, your healthcare provider will teach you how to prepare and inject the medication.
When self-injecting your medication, remember to:
- Inspect the syringe before injecting. Do not inject if you see broken seals, cracked glass, leaking, or particulate matter in the solution or if it is past the expiration date.
- Clean the injection area with alcohol before injecting.
- Discard the needle in a sharps container after use. Never reuse or share the needle or syringe.
Contact your healthcare provider or pharmacist if you have questions or concerns about taking your medication.
Storage
Since you will most likely receive a Demerol injection at a hospital or clinic, you may not need to worry about proper storage. However, if you are required to take this medication at home, keep it stored at room temperature (between 68 F and 77 F). You must keep Demerol out of reach of children and pets.
Off-Label Uses
Healthcare providers may prescribe meperidine for off-label uses, meaning for conditions not specifically indicated by the FDA.
Based on clinical studies, Demerol can be used to prevent shivering after surgery, a common complication of anesthesia. Typically, meperidine is given along with anesthesia during surgery. This combination prevents shivering after an operation.
How Long Does Demerol Take to Work?
The rate at which Demerol can help relieve your pain may vary from person to person. Demerol has a fast onset, so you can feel the medication begin working quickly. It can last about, on average, three hours or so.
What Are the Side Effects of Demerol?
This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.
Common Side Effects
The following side effects commonly reported while taking Demerol include:
- Constipation
- Upset stomach
- Excessive sweating
- Feeling weak
- Lightheadedness or dizziness
- Sedation
Severe Side Effects
Do not hesitate to contact your healthcare provider right away if you are experiencing any severe side effects. Call 911 immediately if you suspect your symptoms are life-threatening or need medical assistance.
Severe side effects associated with Demerol include:
- Breathing problems (e.g., respiratory depression) are most likely to happen within the first 24 to 72 hours after the initial dose and dose increases.
- Increased risk of seizures, especially in people with seizure disorders
- Chest pain or pressure
- Abnormal heartbeat
- Trouble passing urine
- Severely low blood pressure (hypotension)
- Serotonin syndrome, which can cause changes in mental status (e.g., hallucinations, mood swings), vital sign abnormalities (e.g., fast heartbeat, hypertension), muscular effects (e.g., rigidity), and gastrointestinal issues (e.g., nausea, vomiting)
- Misuse or dependence
Long-Term Side Effects
Demerol is only used for short-term pain relief because continued use of meperidine may lead to potential addiction and increase the risk of severe side effects, such as chest pain, abnormal heartbeat, or difficulty breathing.
Report Side Effects
Demerol may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).
Dosage: How Much Demerol Should I Take?
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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
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For injection dosage form:
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For moderate to severe pain:
- Adults—At first, 50 to 150 milligrams (mg) injected into a muscle or under your skin every 3 or 4 hours as needed.
- Children—Dose is based on body weight and must be determined by your doctor. The dose is usually 0.5 to 0.8 milligram (mg) per pound (lb) injected into a muscle or under your skin every 3 or 4 hours as needed.
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For moderate to severe pain:
Modifications
Before starting meperidine, talk to your healthcare provider about any concerns you have about your dosage. Common dose modifications for Demerol are listed below:
- Advanced age (65 years and older): Avoid taking Demerol.
- Kidney problems: Avoid taking Demerol.
- Liver problems: Your healthcare provider will monitor your response to the medication to see if you are a good fit for continued therapy.
- Pregnancy: You should prolonged use of meperidine during pregnancy since the newborn can become dependent on the drug after birth, resulting in life-threatening withdrawal symptoms. This is known as neonatal opioid withdrawal syndrome.
- Breastfeeding: Demerol does pass through the milk of nursing people, so the benefits of breastfeeding should be discussed with the healthcare provider.
- Use of Demerol in children has not been established. Therefore, you should avoid meperidine for your child. You can talk to your child’s healthcare provider for a medication that is proven to be safe to help with their pain.
Missed Dose
Demerol is most often given to you by your healthcare provider or used on an as-needed basis. Therefore, you will likely not need to keep track of scheduled doses.
If you are using Demerol as needed, only take it if you have active pain that needs to be treated. Talk to your healthcare provider if you have additional questions on how you should take your medication.
Overdose: What Happens If I Take Too Much Demerol?
Demerol is a strong narcotic used to relieve pain. As a result, you can become dependent on the medication. This can increase the risks of taking more meperidine than your body can handle, resulting in an overdose.
The signs of a meperidine overdose include:
- Respiratory depression (slowed heart rate and difficulty breathing)
- Cold and clammy skin
- Muscle flaccidity (weakness or paralysis)
- Constricted pupils
- Vomiting
- Somnolence that can lead to a coma
If prescribed Demerol, you can request an antidote called naloxone, also known by its brand name Narcan. Naloxone is a life-saving medication. It works by competing for the same opioid receptor binding sites in your body and displacing opioid binding. By blocking these receptors, Narcan helps to reverse symptoms of opioid overdose.
Whether taking excess Demerol was intentional or accidental, an overdose of meperidine can lead to severe complications or death. It is important to call 911 or medical help immediately following an overdose.
What Happens If I Overdose on Demerol?
If you think you or someone else may have overdosed on Demerol, call a healthcare provider or the Poison Control Center (800-222-1222).
If someone collapses or isn't breathing after taking Demerol, call 911 immediately.
Precautions
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It is very important that your doctor check your progress while you are receiving this medicine. This is to make sure that the medicine is working properly, and to allow your doctor to check for any unwanted effects.
Do not use this medicine if you are using or have used a monoamine oxidase (MAO) inhibitor (eg, Eldepryl®, Marplan®, Nardil®, Parnate®) in the past 2 weeks. Using these medicines together may cause unwanted effects, such as confusion, agitation, restlessness, stomach or intestinal symptoms, a sudden high temperature, an extremely high blood pressure, or convulsions.
Symptoms of an overdose include extreme dizziness or weakness, slow heartbeat or breathing, seizures, trouble breathing, and cold, clammy skin. Call your doctor right away if you notice these symptoms.
This medicine will add to the effects of alcohol and other CNS depressants (medicines that can make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicine, other prescription pain medicine or narcotics, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the medicines listed above while you are using this medicine.
This medicine may cause sleep-related breathing problems (eg, sleep apnea, sleep-related hypoxemia). Your doctor may decrease your dose if you have sleep apnea (stop breathing for short periods during sleep) while using this medicine.
This medicine may be habit-forming. If you feel that the medicine is not working as well, do not use more than your prescribed dose. Call your doctor for instructions.
Using narcotics for a long time can cause severe constipation. To prevent this, your doctor may direct you to take laxatives, drink a lot of fluids, or increase the amount of fiber in the diet. Be sure to follow the directions carefully, because continuing constipation can lead to more serious problems.
Dizziness, lightheadedness, or fainting may occur when you get up suddenly from a lying or sitting position. Getting up slowly may help lessen this problem. Also, lying down for a while may relieve the dizziness or lightheadedness.
This medicine may make you dizzy, drowsy, confused, or disoriented. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or not alert.
Before having any kind of surgery (including dental surgery) or emergency treatment, tell the medical doctor or dentist in charge that you are using this medicine. Serious unwanted effects can occur if certain medicines are given together with meperidine injection.
Check with your doctor right away if you have anxiety, restlessness, a fast heartbeat, fever, sweating, muscle spasms, twitching, nausea, vomiting, diarrhea, or see or hear things that are not there. These may be symptoms of a serious condition called serotonin syndrome. Your risk may be higher if you also take certain other medicines that affect serotonin levels in your body.
If you have been using this medicine regularly for several weeks or longer, do not suddenly stop using it without checking with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. This may help prevent worsening of your condition and reduce the possibility of withdrawal symptoms, such as abdominal or stomach cramps, anxiety, fever, nausea, runny nose, sweating, tremors, or trouble with sleeping.
Using this medicine while you are pregnant may cause neonatal withdrawal syndrome in your newborn babies. Tell your doctor right away if your baby has an abnormal sleep pattern, diarrhea, a high-pitched cry, irritability, shakiness or tremors, weight loss, vomiting, or fails to gain weight.
Using too much of this medicine may cause infertility (unable to have children). Talk with your doctor before using this medicine if you plan to have children.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
What Are Reasons I Shouldn’t Take Demerol?
You should not take Demerol if any of these conditions apply to you:
- Known allergies to meperidine
- If you have short-term or severe asthma
- If you are currently undergoing monoamine oxidase inhibitor (MAOI) therapy (anti-anxiety treatment) or have taken MAOIs within the last 14 days
- If you have gastrointestinal obstruction, including paralytic ileus
What Other Medications Interact With Demerol?
When taking Demerol, you must be aware that other medications or supplements can worsen your side effects or can increase the amount of meperidine in the body.
Do not take the following medications with Demerol:
Taking MAOIs or benzodiazepines with meperidine can cause life-threatening side effects such as difficulty breathing, unresponsiveness, and poor blood circulation. If you are taking an MAOI, you must wait at least 14 days after stopping it to start Demerol therapy. Conversely, you must wait 14 days after stopping Demerol to start an MAOI.
CYP3A4 is a protein that breaks down medications in the body. When this protein is blocked, the medication is not broken down and remains in the body. Therefore, combining a CYP3A4 inhibitor with meperidine will increase levels of Demerol in your body, potentially leading to more side effects.
Additionally, taking other drugs that affect serotonin can heighten the risk of serotonin syndrome, which can be potentially life-threatening. These include:
Other interactions may occur with Demerol. Before starting treatment, tell your healthcare provider about any other medicines you take or plan to take, including over-the-counter (OTC) nonprescription products, vitamins, herbs, supplements, and plant-based medicines.
What Medications Are Similar?
While Demerol is approved by the FDA to treat pain, it is not recommended to be used to treat short-term pain due to its high occurrence of adverse effects. Instead, other safer opioid medications are available that provide the same relief as Demerol.
Other medications similar to Demerol used to treat short-term pain include:
- Morphine
- Hydromorphone
- Hydrocodone and acetaminophen
This is a list of drugs also prescribed for short-term pain. It is NOT a list of drugs recommended to take with Demerol. You should not take these drugs together. Talk to your pharmacist or a healthcare provider about any questions
How Can I Stay Healthy While Taking Demerol?
While OTC pain medications are available, sometimes you may need stronger medications like opioids to feel adequate relief. Despite the stigma opioids carry, they are sometimes appropriate and necessary. However, it's important to follow your healthcare provider's instructions carefully to ensure that you take them safely.
While OTC pain medications are available, sometimes you may need stronger medications like opioids to feel adequate relief. Despite the stigma opioids carry, they are sometimes appropriate and necessary. However, it's important to follow your healthcare provider's instructions carefully to ensure that you take them safely.
Medical Disclaimer
Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.
The author would like to recognize and thank Alexya Rosas for contributing to this article.
