Removing Meperidine from the Health-System Formulary—Frequently Asked Questions

Abstract

Meperidine is FDA-approved for relieving moderate to severe pain and has been widely used since its introduction in the 1930s. However, the drug is no longer considered a first-line analgesic. Many clinicians recommend that meperidine be removed from health-systems or that its use be restricted, due to concerns about adverse reactions, drug interactions, and normeperidine neurotoxicity. In addition, clinical evidence shows that meperidine has no advantage over other opioids for biliary colic or pancreatitis. The formulary status of meperidine has been extensively discussed at University of Utah Hospitals and Clinics. The Pharmacy and Therapeutics Committee has been working with hospital staff to assess the impact of either removing meperidine from the formulary, or limiting its use. The Drug Information Service developed this document to help pharmacists respond to prescribers' questions and to alleviate the prescribers' concerns about these changes. Information is provided comparing meperidine with other opioids, including dosage equivalency, pharmacodynamics, pharmacokinetics, cost, adverse effects, and drug interactions. Where available, alternatives to meperidine are suggested for various indications.

Current management of migraine in US emergency departments: An analysis of the National Hospital Ambulatory Medical Care Survey

“…Meperidine use is becoming much less common nationally as pharmacy committees restrict the use of this medication because of concern about toxic side effects (22–24). For patients with migraine, hydromorphone has largely filled the void previously occupied by the more toxic opioid.…”

Management of Pain in the Emergency Department

“…It has been written for years that meperidine should not be included in the initial treatment regimen for either adult or pediatric ED patients [234,235]. Since even the historical "advantages" of meperidine (e.g., potential for less spasm of the sphincter of Oddi) have been debunked [236], the known pharmacological shortcomings of the drug (e.g., risk from normeperidine build-up) would seem to outweigh any particular reason for its first-line use in the ED.…”

Current treatment options in the management of severe pain

“…It is not as popular now and is no longer considered a first-line analgesic due to concerns over adverse reactions, drug interactions (see Table 5) and norpethidine neurotoxicity. 11 Oxycodone This drug is licensed for severe pain and has twice the potency of morphine. It undergoes first-pass metabolism (50 per cent) when taken orally, initially 5mg four hourly.…”