Demerol ======= þ Problems with normeperidine buildup: - Meperidine toxicity cannot be reversed with naloxone, which may in fact be harmful since it will reverse the opioid-induced CNS depression caused by meperidine, while not reversing the CNS excitation caused by normeperidine. Naloxone was found to exacerbate the convulsant activity of meperidine and normeperidine.1 When normeperidine induced-seizures occur, appropriate anticonvulsant therapies must be used.1,2 There are five major factors that predispose patients to meperidine induced- seizures: 1) doses greater than 100mg every two hours for greater than 24 hours; 2) renal failure; 3) alkaline urine which decreases excretion of normeperidine; 4) co-administration of hepatic enzyme inducing drugs; and 5) co-administration of phenothiazines which can decrease the seizure threshold.5 (from UPMC Pharmacy, 2005) þ Demerol-Free ED - in 1999, the ED staff of Chestnut Hill Hospital, near Philadelphia, decided to eliminate Demerol (meperidine) from its ED entirely Date sent: Mon, 30 Jun 1997 14:10:08 -0500 Send reply to: EMS-L@listserv.ACNS.NWU.EDU From: "Edward A. Michelson" To: ems-l@listserv.ACNS.NWU.EDU Subject: treatment of sickle cell pain crisis I am curious what ems systems are doing to treat sickle cell pain crisis. Do these patients get IV starts and narcotics in the prehospital setting? Our institution has recently decided to take meperidine off of formulary in part due to complications of nor-meperidine build up in patients receiving large and repeated doses of meperidine. We have had several sickle cell patients, who often "require" lare doses, suffer seizures. Meperidine is reportedly also more likely to create a euphoric effect than other narcotics. Many of our sickle cell patients have a strong preference for meperidine over other narcotics, with some claiming multiple allergies in an attempt to avoid the alternative drugs. Some patients have been found calling ahead to see who is working in the ED, as some attendings are less likely to prescribe meperidine than others. By taking it off formulary, these problems may be reduced.