Central nervous system excitatory effects of meperidine in cancer patients

Abstract

The analgesic meperidine has been reported to produce signs of central nervous system excitation in human beings. To determine the relationship between signs and symptoms of central nervous system excitation and plasma levels of meperidine and normeperidine, we studied 67 patients receiving meperidine for the relief of postoperative or chronic pain. In 48 patients, excitatory effects ranging from mild nervousness to tremors, twitches, multifocal myoclonus, and seizures were directly correlated with accumulation of normeperidine in plasma. Evidence of compromised renal function occurred in only 14 of the 48 symptomatic patients, suggesting that renal dysfunction may contribute to but is not the sole factor in the accumulation of normeperidine or its relation to adverse neurological signs. In a second study we surveyed mood alterations in 47 patients receiving meperidine and 29 receiving other narcotic analgesics for postoperative pain. The repeated administration of meperidine was associated with adverse alterations in various elements of mood (e.g., apprehension, sadness, restlessness).

Mu Opioids and Their Receptors: Evolution of a Concept

“…Meperidine, the prototypic 4-phenylpiperidine, is a widely used clinical analgesic, although its utility is limited by the toxicity and epileptic actions of its N-demethylated metabolite normeperidine (Kaiko et al, 1983;Inturrisi, 2002). Methadone is another muselective analgesic, and is the major drug in the acyclic analgesic class.…”

Opioid Therapy for Chronic Nonmalignant Pain

“…The opioid-induced euphoria experienced by addicts occurs rarely among patients who receive an opioid for pain (179)(180)(181). Indeed, the usual experience of patients is dysphoria.…”

Molecular, Anatomical, Physiological, and Behavioral Studies of Rats Treated with Buprenorphine after Spinal Cord Injury

“…However, prolonged use of morphine may lead to tolerance and, subsequently, withdrawal symptoms (Fernández-Dueñ as et al, 2007;Ledeboer et al, 2007;Noble and Roques, 2007). In trauma, rat model compounds, such as butorphanol, nalbuphine, meperidine, pentazocine, and codeine, can be used to alleviate acute pain, but buprenorphine is the analgesic recommended by veterinarians due to its potency and long-lasting duration (Kaiko et al, 1983;Gear et al, 1999;Katzung, 2001;Roughan and Flecknell, 2002). Moreover, subcutaneously administration of 0.05 mg=kg reduces pain sensitivity after postoperative surgeries (Curtin et al, 2009).…”