Sunday September 17, 2006
Why PO Demerol is not a good idea !!

Overall, demerol (meperidine) is falling out of favor and has been referred by many as 'demon' due to neurotoxicity of its metabolite normeperidine. Fortunately PO (by mouth) demerol is not as popular as IV but it should be avoided at all. PO demerol is way more dangerous than IV demerol. 50% of PO demerol get metabolized first pass via liver and give high level of normeperidine in blood which has long half life of 15-30 hours even with normal kidney function and may accumulate to cause tremors, myoclonus, hallucinations and seizure. Hemodialysis has been described to help in normeperidine toxicity 1.


See nice review at medscape.com - free registration required: Meperidine is Alive and Well in the New Millennium: Evaluation of Meperidine Usage Patterns and Frequency of Adverse Drug Reactions (Dr. Seifert and Dr. Kennedy, Ref: Pharmacotherapy 24(6):776-783, 2004)



Reference: click to get abstract

Successful treatment of normeperidine neurotoxicity by hemodialysis - Am J Kidney Dis. 2000 Jan;35(1):146-9.