Meperidine: A Perspective on Its Contemporary Use

Abstract

Meperidine, a phenylpiperidine derivative, was the first synthetic opioid. Introduced in 1939, it has remained a widely used agent. It has been estimated to constitute approximately 40% of total analgesic utilization in Western countries.1 Despite this widespread utilization, there is considerable debate on the wisdom of the continued use of this drug. Chalverus2 in this issue of the Journal of Pharmaceutical Care in Pain & Symptom Control has made a contribution to this debate by reviewing the toxicity of this opioid. The pharmacokinetics of meperidine certainly make it far from an ideal opioid. There is extensive first-pass hepatic metabolism; the oral bioavailability has been reported to range from 40 to 60%.3 Administered intravenously, single dose meperidine provides a short duration of analgesia. Extensive redistribution initially to well perfused regions occurs and repetitive dosing results in uptake by adipose tissue. Despite the acknowledged relatively short duration of action of meperidine of one to three hours, it is not uncommonly administered at intervals of ev-