title: Meperidine is alive and well in the new millennium: evaluation of meperidine usage patterns and frequency of adverse drug reactions.
abstract: OBJECTIVE
  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 < or = 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Pharmacy, Texas Tech University Health Sciences Center, Lubbock 79430, USA. charles.seifert@ttuhsc.edu
authors.forename: Charles F
authors.initials: CF
authors.lastname: Seifert
authors.forename: Shalyn
authors.initials: S
authors.lastname: Kennedy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D017723:Drug Utilization Review; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008614:Meperidine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D008875:Middle Aged; D051437:Renal Insufficiency / Q000150:complications; D018570:Risk Assessment; D013781:Texas
chemical_list: D000701:Analgesics, Opioid; D008614:Meperidine