Clinical Effects of Meperidinein Hospitalized MedicalPatients RUSSELL
M
is
EPERIDINE
quently gesic.
This
dine
produces
part
report
by
the
and
The ously.1
characteristics dosage and drugs
and route
given.
or pharm-
medical
wards
forms
collected
a
drug
and is
the
prescribing
physician
terviewed
to
determine
the
tained from termination of
possible
or “don’t the physician. of therapy adverse
180
initially
in this This
know”)
The reasons and descriptions reactions
are
for also
Drug Medical
Mass.
is
between
by a reactions
clinical that or
pos-
according
based
1966
on
and
included
data
accumu-
1975
patients States
on in and
meperidinc
to
are
366 (1.4 per cent) orally and 3263
received
caused second
probably,
medical the United
of whom meperidine
26,294 22 hosabroad,
received (12.4 per
parenterally.
Results Patient
Characteristics
mean
age
recipients
was
preciably
different
cipients
disease
(23
per
of hospitalization
not
cent)
The
ap-
of
oral
hospital;
the
most
(first) oral
re-
about
recipients
was
died. common
diagnosis recipients;
recipients, cardiovascuand neoplastic diseases
were
most
common.
was
appreciably Journal
not
parenteral
cent
about
oral and parenteral values for blood differ
was
and
the
of primary cent) among
tion
did
per in
I)
meperidine
it oral
15
among parenteral lar (23 per cent)
for both Admission
3634
of parenteral
Ncoplastic category (43 per
the years;
for
while
cent
(Table
of 53
About died
10 per
is ob-
drug
meperidine
report. report
cent)
the
independent
pharmacologist
recipients.
is in-
indication.
A Report from The Boston Collaborative Surveillance Program, Boston University Center, 400 Totten Pond Road, Waltham, 02154.
by
The
on the for all
therapy is discontinued, a judgof the drug’s efficacy (“satisfactory,”
“unsatisfactory,”
definitely,
caused
patients’
prescribed, When ment
use
to record admitted paon
diagnoses of administration
When
of previ-
(nurses
on
are
findings
described
self-coding on consecutively Data
judged clinical
physician
made Adverse
sibly
lated
general
monitors
standardized, information
Sur-
later
were the
mcperidine monitored Drug
been
stationed
tients.
quantitative
is
An
Mass.
adverse
attending that
effect.
WalTham,
suspected
the
likelihood
hospitalized pitals in
and have
Trained
a.cists)
judgment pharmacologist.
(BCDSP).
methods
the adverse
M.D.
each
reaction,
adverse pre-
JICK.
For
drug the
Methods
BCDSP
HERSHEL
recorded. judges
purpose
The
provide
Collaborative
Program
Material the
to
and
meperiare
acute toxicity of medical patients
Boston
veillance
effects
in nature.
is
data on the in hospitalized
few
these
anal-
probably that
relatively that
Pharm.D.
fre-
strong
a belief
minor
this
more
other usage
from
and
dominantly of
any
widespread
in
effects
prescribed
than
stems
R. MILLER.
of
Durathe
same
recipients. urea nitrogen among
Clinical
oral
Pharmacology
and
CLINICAL
EFFECTS
OF
MEPERIDINE
TABLE Characteristics
I
of Meperidine
Recipients Per
recipients
Characteristic
Category
of
Primary
(First)
Diagnosis
Neoplastic
43.4
22.6
Cardiovascular
19.7
22.7
Gastrointestinal
5.2
16.6
Pulmonary
6.6
7.3
Symptoms
4.6
7.8
Genitourinary All other
3.3
Days
in
29.6
33.2
10
to
19
35.6
33.9
20
or
more
34.8
32.9
72.1
71.3
14.5
14.6
4.4
5.5
9.0
8.6
than
10
Admission
Value
Less
than to
49
50
or
more
parenteral
of
Urea
Blood
(mg/dl)
Nitrogen
25
25
Unknown
or
not
specified
recipients
and
all
other
moni-
gesics;
about
cipients
patients.
A Meperidine
Oral
was
for pain drug also adjunctive
nostic
liver
used
relief, had
These
adjunctive
ferent
from
analgesic in pain
cardiac
uses
not
doses ingly,
of meperidine are for the remaining
meperidine
usually
therapy
80
per
cent
who
received
were
also
given
other
April
1978
divided
75 and
The average quotient of
the
by
mg was 25 per
the
number
pa-
all recipients. The total amount meperidine given during hospitalization
one
the
oral
strong
dose
recipients; of oral
or two
discussion
excluded. meperidine
drug
for
or mild
between than
varied
100
from
The tending better
pain
The
anal-
rate,
clinical for
first in
less
cent of oral in 2 per cent given
the mg
than
efficacy
relief
measure
to
the
of
dose)
mg
was
cent
30
in
2 Gm or recipients. as judged
was given
efficacy percentage
of of per
more
of mcperidine
of pain,
of is,
last
80 per
100
recipients of parenteral
physicians, when it was that
and about
75
55 per
with
been
the
of parenteral recipients. dose (calculated as
cent
to
and
since
for
of
cent daily
total
given
less
than
About
was
of to
parentcral 8 per
mg
recipients
days
tions recipients
50
oral
dif-
given. Accorddiscussion of
have
of
re-
quite
influencing efficacy, all pareceived meperidine for indicapain
dose of the
of parenteral analgesics.
cent given
the
of factors tients who other
unit cent
cent
other
are only
and
to diag-
75 per
received
or to sur-
uses
tients
exthe use
catheteri-
endoscopy)
gery.
per
almost
prior
(e.g.,
biopsy,
II)
whereas substantial
medication
procedures
zation,
(Table
Therapy
meperidine
clusively parentcral as an
3.9 19.1
17.2
Hospital
Less
tored
Per cent parenteral recipients
cent oral
when by
at-
significantly parentcrally. was
the
failure
of
unsatis181
MILLER
factory for
ratings which
made.
among a
Oral
drug of
meperidine
satisfactory while
all
judgment
in
22
parenteral
exposures
cent
was
judged
un-
of
meperidine
unsatisfactory
in
11 per
At
rated
drug routes
cent.
TABLE Characteristics
Influencing lower
Efficacy
meperidine
(Table unit
III)
doses
failure rate was higher. This was true both physician and patient assessments
recipients, was
JICK
Factors
efficacy
was
per
AND
effectiveness, for of administration,
oral
and parenteral and for patients
II
of Meperidine
Therapy* Per cent
Characteristic
Per cent
oral recipients
parenteral recipients
92.9
52.8
3.0
41.0
Indication Pain Diagnostic
and
preoperative
adjunct
Other
4.1
6.2
Yes
81.8
74.5
No
18.2
25.5
Administration
Unit
Dose
of Other
Analgesics
(mg)
25
75
7.8
100
9.0
8.8
Other
4.2
3.0
Daily
Less 50
than to
50
99
46.4
42.1
34.2
39.7
149
10.5
150
to
199
3.7
9.9 3.8
200
to
249
2.0
1.0
250
or
more
3.2
4.5
100
Dose
(mg)
than to
100
999
30.2
46.9
60.7
46.3
1000
to
1999
6.6
5.0
2000
or
more
2.5
1.8
Physicians’
Judgment
time indications received
Quotient
of Efficacy-Failure portion
of
for
pain
nieperidine of
Percentage of rating of either which no judgment
182
(mg)
to
Less
Only
Dose
25.2
100
Total
*
55.2
75.1
Average
who
7.8
3.9
50
total
dose
divided
unsatisfactory “satisfactory” was made.
this table were by
Ratest pertains
counted number
in of
exposures among or “unsatisfactory”
22.2
to all mneperidine preparing
days
the
between all
recipients;
remaining
first
and
(Irug exposures was made; does
The
10.9
Journal
only
patients
sections. last
dose.
for not
which include
of
Clinical
an
efficacy cases in
Pharmacology
the for of
CLINICAL
EFFECTS
OF
TABLE Influence of Indication, on Efficacy (Failure
MEPERIDINE
III Diagnosis, Rates) of
and Unit Meperidine*
Dose
Failure
rate
(%)
Oral Patients Patients of
with
and
pain
neoplastic
primary given
disease,
recipients
Parenterai recipients
diagnosis unit
of
dose
50
mg
31.8
24.8
75
mg
18.2
15.4
100
mg
13.3
10.3
Patients with pain of other diseases, 50
and primary given unit
diagnosis dose of
mg
19.6
9.4
-
5.1
75mg 100 *
Failure
which
rate an
Since
**
12
and
cancer.
is
was
or
less
without
percentage
with
rates
a primary was
parenterally doses were
declined
from
13.8
to 29 years
old
70 years and to be influenced
nmeaning
affect
per
to 6.2
cent per
central
drug
Adverse
could
not
Reactions
poses adverse if more
Adverse
reactions
3268 1978
parenteral
among
all
exposures
cent
20
for
were
recipients.
minor
oral
attributed
to
of the 366 per cent) For
pur-
with
the
of
were
the
meperidine,
nervous (1.2
per
system cent).
common
system effects depression,
activity,
agitation,
tremor,
were
constipation effects
central
nervous
disorientation, and
or malaise Less frequent
nervous respiratory
re-
effects Most
effects
effects and included feclings, hallucinations,
chosis. Drowsiness commonly observed.
were
adverse parenteral
vomiting; some Neuropsychiatric
most
is some-
disturbances
gastrointestinal
nausea and was observed.
espe-
ones,
recipients
an
adverse the fre-
reactions,
minor
central common
oral
only once; experienced
the most commonly reported actions (2.7 per cent). Among
system bizarre V)
adverse
gastrointestinal
mg
patient
some
of
of
and
100
was counted reaction was
the relatively underestimated.
system.
be determined.
each
or
quency
recipients, were most
rethe of
IV,
75
the most important counted. Therefore,
appear drugs
meperidine unit dose, on dosage
IV
Table reaction than one
Among
doses
in patients
nervous
of
received
by a patient, effect was cially what
drug, increased. unit
meperidine in 16 (4.3 per cent) oral recipients and in 102 (3.1
are not listed.
of
in patients
(Tables
diagnoses
and
in
over. Dose did not by the use of other the
primary
effective
100-mg
Since three fourths of oral cipients received a 50-mg influence of various factors
April
little
Dose
of
exposures
diagnosis less
administered given as age
usage
unsatisfactory
nonneoplastic
have
Influencing
example,
of the
of
made.
with a primary diagnosis of neodisease than in patients with other diagnoses.
With smaller
oral
the
patients
the failure
Factors
that
as
rating
Meperidine
patients plastic primary
For
defined
efficacy
meperidine,
with
5.9
mg
included headache, and
psy-
was also central vertigo, hyperdepression. 183
MILLER
Cardiovascular among nine case
adverse
parenteral instances of
ute).
Other
only
among
(150
adverse
effects
parenteral
minor
injection
site
tivity reactions, Two patients
and were
to meperidine pital.
mg
beats
per
min-
dominal
also
were
seen
additional peared
to the
came appeared
degree
of
daily when
sensi-
they
to
receiving in the
was
hos-
verse
de-
TABLE Reactions
the and
doses
patient
after for four meperidine
receiving days; was
a
100-mg
she became discontinued;
(Table
V).
judged and
dose
did
to Meperidine*
Gastrointestinal
reaction
Oral
recipients
Disturbances
Nausea
or
vomiting
Constipation
Nervous
Central
recipients
System
Disorientation, tions, or
bizarre psychosis
Drowsiness
or
8
(2.2)
27
(0.8)
2
(0.5)
7
(0.2)
2
(0.5)
13
(0.4)
3
(0.8)
8
(0.2)
3
(0.09)
3
(0.09)
Effects feelings,
hallucina-
malaise
Vertigo Respiratory
depression 1
Coma
2
(0.3)
Headache Convulsions
or
Hyperactivity
tremor or
agitation
Depression Cardiovascular
(0.06)
1
(0.03)
9 (0.3) 1
(0.03)
7
(0.2)
4
(0.1)
4
(0.1)
3
(0.09)
2
(0.06)
Injection
Site
Rash,
or
Anuria
Complications
Pruritus,
or
Hives
Diaphoresis Total
184
(0.09)
2
Tachycardia Retention
Figures
(0.09)
3
Effects
Addiction
*
3
Hypotension
Urinary
in
16 columns
are
number
of
patients,
with
per
cent
(4.3) of
Time
recipients Journal
102
(3.1)
in
parentheses.
given
of
Clinical
not. ad-
However, “definitely” in both
Pareuteral Adverse
apde-
agitated pentaz-
IV
Attributed
ab-
craved
patient psychic
relief but placebo had life-threatening
experiences
75 the
had
and
meperidine. Another have developed
to
of
when
nausea
only two of these were related to meperidine,
have
21 hospital;
discontinued, cramps
oeine provided Seven patients
physical
Adverse
after 16 days
pendence
retention and hours, various
dependent
over
drug
in-
diaphoresis. physically
patient
a mild
and
complications,
before
Another
developed
pendence
included and one
and
recipients
cluded six cases of urinary one case of anuria for 24
JICK
occurred
effects
recipients of hypotension
tachyeardia
AND
Pharmacology
in-
CLINICAL
EFFECTS
OF
MEPERIDINE +-4
0
‘a
‘aa
+2
‘a
O
a
4
‘-4
0
5 1-44
Za .0
V
a
a.
0
I
a ‘5
a.
#{149}0
‘a
o a
.0
a a
a
a
.2
j
‘a ‘-4
a
*2
a
0
9 o
a
a.
a
a.
+2
a
#{149}0 ‘4
a
o . *.2
a
9+2
+2
-o
4a
,-.
a+2
a
a
‘4
a
a
a a 0 a
a a
a a
a
a
a
a
.0
0
-ca aa
a P1
a
a. 0
a‘-4
a
8
.
a.0
Ora.b
29
o ‘-4
a.
.5
‘a
a
0
a ‘-
no a o
a.
‘a
0 0 .5
a
bL
*2 .
a
‘-4
to
a a
‘4
C
8
8
bi
O,a
a a
0
0
-
‘a
*2
8
V
-a
a
0
8 a
.8 ‘an
a 0
8
I
-
a
a 5 o a
9 o a.
a
a
a
.0
o
Ca
a
a
0
‘4
‘a
a.
p.
a
a
0
-
a -4)
a
a
0
0
0 a
0 a
a.
0
a.
a 0
P.
a
a a 0 0
U)
a a
a.
I
0 0
‘a 542
-4-
a4
a a
a
a.
.
I-
‘0
a
4-,
m2.
a
a
0 a ‘4
a .
a
‘a 1-47
Sea
.2
.8 a
.9.9 a
a
‘-4
a.Ca
0 *2
a
a
a (-4
‘a a
a
‘4
,
a 0-’a
a
a a
‘4
94’4a
(-
b’a 90
00p.
0
a
0
a
,
+2
‘a
0
am
0
April
1978
I:-
185
MILLER
stances other drugs were implicated. Two patients actions
that
were
ably” related had reactions
thought
to
reactions
depression,
coma,
re-
“prob-
and
three related.
ably
and
Influencing
Adverse
the
(Table
The
frequency
of
to oral creased
and as the
parenteral unit dose,
dose, and frequency
Frequency
Reactions
all
the total dose also increased
of
parenteral
per
cent
who
adverse
reactions
meperidine the average
not
Influencing
the Frequency Oral
Factor Dose
No.
frequency
other
of adverse of
by blood The
who
Similar meperi-
urea
age,
renal
function
nitrogen
mean
body
experienced
Reactions
adverse
Number ARs
Parenter
al recipients
of pts.
Number ARs
with
(%)
No.
14
50
270
0
(0.0)
12
(4.4)
261 1,730
with
4
(1.5) (2.6)
75
25
2
(8.0)
869
28
(3.2)
100
40
4
(10.0)
316
11
(3.5)
Average
Daily
Less 50 100
Dose
than
(mg)
50
to 99 to 149
95
0
(0.0)
166
8
(4.8)
59
5
(8.5)
598 1,564 909
(0.8) (2.4)
29
(3.2)
150
to
199
17
2
(11.8)
200
or
more
22
3
(13.6)
111
2
(1.8)
2,077
42
(2.0)
212
12
(5.7)
1,044
26
(2.5)
21
(16.9)
Total
Dose
100 1000
Days
in
Less
100
8
(11.1)
9
(9.0)
(mg)
than 100 to 999 or more
Less
72
5 38
36
4
(11.1)
124
Hospital than
108
2
(1.9)
1,079
20
(1.9)
10
to
19
130
5
(3.8)
1,101
28
(2.5)
20
or
more
127
11
(8.7)
1,070
40
(3.7)
290
17
(5.9)
2,165
70
(3.2)
1
(1.3)
1,103
19
(1.7)
Concomitant
Yes No
10
Use
of
Other
Analgesics
76
The
Journal
of
Clinical
of reac-
(%)
45
sex, levels
weight
to Meperidine
recipients
was
with
VI of Adverse
1.7 anal-
reactions
correlated
admission.
patients
reac-
while
reaction. for oral
or impairment
as measured
adverse
receive
adverse observed
padur-
(mg)
25
186
of pts.
an
of
analgesics an
not
significantly
on
became larger. The as the duration
did
doses
cent
meperidine,
were
survival,
indaily
TABLE Factors
had
had
prob-
total
per
other
hospitalization
dine. The
VI)
3.2
received
to
this
larger
About
tion gesics findings
Factors
increasingly
who
ing
hypotension.
Unit
reflects
increased;
mepcridine.
tients
respi-
convulsions,
hospitalization
of
be
included
JICK
of
“definitely” adverse
to meperidine, judged “possibly”
Life-threatening ratory
also had
AND
Pharmacology
CLINICAL
tions
was
5.2
cipients
pounds
without
difference
less
than
adverse
was
not
EFFECTS
that
of re-
reactions;
statistically
this
Our data meperidine
of
oral
indicate occur
recipients
parenteral cur more all
that in
of
recipients often at
the
were
in
The
to
meperidine
parenterally
ad-
caused
serious
number
of patients.
disturbances sisting of
commonly
adverse
reported
category
per and
cent), chiefly convomiting. About 1
of parenteral
recipients
had
toward
gastrointestinal
effects.
clear should
why orally provoke a
administered higher frequency
are
effects,
thought
to
meperidine to the received
stomach. somewhat
meperidine
was
cancer patients may partially Among ents,
central common
this
category
(1.1
system per
observed urinary
verse
effects
enteral
bizarre
psychosis) (0.4
were per
cent).
retention, were
seen
only
patients
April
1978
observed
clinically
cipients
meperidinc,
were and
in
serious
13 per
exhigh (0.4
cent
of
In concases of
with
morphine.2
been
noted
pre-
morphine substitutes, the respiration. We significant
respiratory
reported
studies
therefore,
using
we
same
degree
Previous
the have
is given
expected
gesics apparently nomenon.#{176} In of oral
was
cent
of
patients
pain
is this
recipients
mg
than
The
efficacy
quate
dosage
in-
pain.6
Unfortunately,
for
finding. were
a primary This
patients other
medical other
patients.
inpatients strong anal-
a widespread series, about and
is to usually
or
less
60 per
This most
in
about
may
pheper
80 cent
received unit and the average
recipients.
as-
when
reliable
with
than
of and
recipients or less, 150
that
disease.
cancer
severe
parenteral of 50 mg
less
neoplastic
ad-
to
it is consider-
here support this parcnteral meperidine
Undertreatinent with meperidine
dose
and
since
more
shown
parenterally.5
in of
doses,
respiration
orally,
potent
effective
cannot
causes less in experi-
as morphine.4
studies
meperidine
used pain
equianalgcsic
depressed
fre-
par-
respiratory
morphine is with severe
illnesses;
meperidine
less
to have
that mcperidine depression. Indeed,
mental
have
both
relatively effects
have
However, for patients
conclude respiratory
feelings,
definitely
at
effects other depresses
were
diagnosis
respirahypotwo life-
to
Like
reported oral and
verse reactions; they included tory depression, coma, convulsions, tension, and cardiac arrest. Only reactions
and,
occurred
and
differences
viously.3 meperidine
cent had
recipients
data Both
ad-
cribed
These
be
among
they
neuropsychiatric
disturb-
other
of
reactions
reactions) was surprising. we have not observed any
it is given
life-threatening
threatening
cent
adverse trast,
less
recipients.
Seven
per
when
Hypoten-
and
strongly
adverse
frequencies. The of neuropsychiatric
ably
were
most
also
documented,
exception,
for
within
neuropsychiatric
pected frequency
observed
previously
this recipi-
and
one
the
often
effects
cent),
(disorientation,
quently
of and
meperidine
with
and
recipients Since oral
more
the
been
un-
effects
parenteral drug, the difference.
of
have
depression. more often
irritating
oral doses.
prescribed
nervous
hallucinations, sion,
be
were
implicated.
undrug
these
to
Further, lower than explain
is
mediated
known
parenteral
most ances
since
be centrally
is not
It
drugs
depression in only three patients (less than 0.1 per cent of recipients), whereas with morphine nearly 1 per cent of re-
among oral meperiminor gastrointestinal
(2.7 nausea
gastrointestinal
of
and ocNearly
drug most
cent
cent
a small
of adverse reactions dine recipients was
per
oral
whereas
ministered effects
per
in hospital higher doses.
reactions
minor,
3
other
All
adverse reactions about 4 per cent
and
MEPERIDINE
stances
significant.
Discussion
to
OF
of
doses daily 90
per
be
made-
patients
with
severe
we have
no informa187
MILLER
tion on the by monitored pain
severity patients,
relief
cannot
are
be
of
pain and
experienced our data
insufilcient.
certain
AND
on
Therefore,
that
JICK
also
definitely
tions
were
patients
were
analgesics,7 between
to a previous
study
we did not and adverse
age
of strong
Boston
find a correlation reactions. Since
older
patients
received
could tween
have age
obscured an and frequency
lower
doses,
this
association of adverse
bere-
actions. Summary
per
and
cent)
3268
meperidine
received
(12.4
parenterally
more admissions. the most common diagnosis
(43
cipients;
among
cent)
and each)
among
re-
recipients
almost
use
(41
per
preoperative
cent)
lief
of recipients,
in 22 per
enteral
cent
mcperidine
factory effective
in 11 per in patients
nosis
of
tients Miiior
ncoplastic
was
most
actions (2.7
per
commonly
ex-
recipients
had
nervous (1.2
than
in
adverse
life-threatening only
adverse
however,
two
judged and in
definitely related to both instances other
of
Canada
Hospital, Milan; der Freie Uni-
Boston
Collaborative
Program
has
been
Drug supported
Surveilby
a grant
New
par-
these
Zealand,
hospital
unsatis-
system per cent).
actions.
Hospital;
Hospital,
(1
pa-
No. and
1.
2.
mepcridrne, drugs were
Williams
GM-165-38-02), and Health Department.
General
NIGMS
the
Scottish
Grant Home
Miller,
R.
11.:
Drug
surveillance
utilizing
the
R. R.: Analgesics. In Drug Effects Hospitalized Patients, Miller, R. R., and Greenblatt, D. J., Eds. New York, Wiley, 1976, Chapt. 15, pp. 133-164.
Miller, in
rewere
Roger University
epidenmiologic methods: a report from Boston Collaborative Drug Surveillance Program. Amer. J. ffosp. Pharm. 30:584 (1973).
re-
effects Seven
time
(Brown
References
among oral meperidinc recipients cent); among parenteral re-
cipients central were most common
Up-
while
meperi-
primary diagnoses. disturbances were reported
the
physicians pain rerated
disease
‘s
pital, Glasgow; Italy-Desio Gcrmimany-Klinikumn Steglitz The
cent. The drug was less with a primary diag-
with other gastrointestinal
University
of
Ariz.-Arizona Va.-Virginia
ROl GM 23430-01) from the National Institute of General Medical Sciences (NIGMS) and in part by grants from the United States Food and Drug Administration (1 ROl FD00920-01), the Canadian Health Protection Branch, the Israeli Ministry of Health, time Tiadassaim Medical Organization, the Kupat-Holini, Auckland Hospital, Auckland,
Oral
by attending unsatisfactory
Hospital
Center; Tucson, Center; Richmond,
Joseph
lance
as a diagnostic
adjunct.
the Pro-
vei-sit#{228}t Berlin.
diseases common.
prescribed
dine was judged to have provided
188
oral
neoplastic were most
was
or
(93 per cent) for pain relief, the parenteral drug also had sub-
stantial
the
one
disease was of primary
parenteral
meperidine
clusively whereas
received
during
Neoplastic category
per
cardiovascular (23 per cent
cent)
in
Surveillance
London, Ontario; Israel-Hadassah-Hebrew University Hospital, Jerusalem, Beilinson Medical Center, Petah Tiqva, Asaf-Harofe Hospital, Zerifin, and Rambani University Hospital, Haifa; New Zealand-Auckland Hospital, Auckland, and Hutt Hospital, Wellington; Scotland\\reStel.Il Infirmary and Stobhill General fibs-St.
meperidine
per
participated
Drug
University Medical
Commonwealth
patients program,
have
are: Boston, Mass.-Lemuel Shattuck Hospital, Peter Bent Brigham Hospital, Boston City Hospital, Veterans Administration Hospital, Isiassachusetts General Hospital, and University Hospital; Providence, R.I.Roger Williams General Hospital; Syracuse,
Medical
(1.4
and
which
gram
state
orally
related.
Collaborative
N.Y.-State
Of 26,294 hospitalized medical monitored in a drug surveillance
reac-
Acknowledgments Hospitals
In contrast
Oral
dose
Adverse
we
undertreated.
366
implicated.
1.
Kornetsky, C., Hynmphries, 0., and E. V.: Comparison of psychological of certain centrally acting drugs Arch. Neurol. 77:318 (1957).
Time Journal
of Clinical
Evarts, effects in man.
Pharmacology
CLINICAL 4.
5.
Lasagna, L.: The clinical evaluation of morphine and its substitutes as analgesics. Pharmacol. Rev. 16:47 (1964). Eddy, N. B., Halbach, H., and Braenden, 0.
J.:
like
Synthetic effect.
17:569
Marks, treatment
April
1918
substances Clinical
side-effects,
6.
EFFECTS
addiction
with
M.,
and
of medical
Sachar,
Bull. E.
inpatients
cotic
WHO
J.:
Under-
with
nar-
analgesics.
Ann.
Int.
Med.
78:173
(1973). 7.
Bellsville, E.,
J. W., Brown,
and
on pain 217:1835
potency,
(1957).
R.
MEPERIDINE
morphine-
experience: liability.
OF
Reprint Miller veillance
at
tham,
Mass.
Forrest,
relief
B. from
W. H, W.:
Jr.,
Influence
analgesics.
Mifier, of
age
J.A.M.A.
(1971).
requests should the Boston Program, 400
be addressed Collaborative Totten Pond
to: Drug Road,
Dr. SurWal-
02154.
189
M
is
EPERIDINE
quently gesic.
This
dine
produces
part
report
by
the
and
The ously.1
characteristics dosage and drugs
and route
given.
or pharm-
medical
wards
forms
collected
a
drug
and is
the
prescribing
physician
terviewed
to
determine
the
tained from termination of
possible
or “don’t the physician. of therapy adverse
180
initially
in this This
know”)
The reasons and descriptions reactions
are
for also
Drug Medical
Mass.
is
between
by a reactions
clinical that or
pos-
according
based
1966
on
and
included
data
accumu-
1975
patients States
on in and
meperidinc
to
are
366 (1.4 per cent) orally and 3263
received
caused second
probably,
medical the United
of whom meperidine
26,294 22 hosabroad,
received (12.4 per
parenterally.
Results Patient
Characteristics
mean
age
recipients
was
preciably
different
cipients
disease
(23
per
of hospitalization
not
cent)
The
ap-
of
oral
hospital;
the
most
(first) oral
re-
about
recipients
was
died. common
diagnosis recipients;
recipients, cardiovascuand neoplastic diseases
were
most
common.
was
appreciably Journal
not
parenteral
cent
about
oral and parenteral values for blood differ
was
and
the
of primary cent) among
tion
did
per in
I)
meperidine
it oral
15
among parenteral lar (23 per cent)
for both Admission
3634
of parenteral
Ncoplastic category (43 per
the years;
for
while
cent
(Table
of 53
About died
10 per
is ob-
drug
meperidine
report. report
cent)
the
independent
pharmacologist
recipients.
is in-
indication.
A Report from The Boston Collaborative Surveillance Program, Boston University Center, 400 Totten Pond Road, Waltham, 02154.
by
The
on the for all
therapy is discontinued, a judgof the drug’s efficacy (“satisfactory,”
“unsatisfactory,”
definitely,
caused
patients’
prescribed, When ment
use
to record admitted paon
diagnoses of administration
When
of previ-
(nurses
on
are
findings
described
self-coding on consecutively Data
judged clinical
physician
made Adverse
sibly
lated
general
monitors
standardized, information
Sur-
later
were the
mcperidine monitored Drug
been
stationed
tients.
quantitative
is
An
Mass.
adverse
attending that
effect.
WalTham,
suspected
the
likelihood
hospitalized pitals in
and have
Trained
a.cists)
judgment pharmacologist.
(BCDSP).
methods
the adverse
M.D.
each
reaction,
adverse pre-
JICK.
For
drug the
Methods
BCDSP
HERSHEL
recorded. judges
purpose
The
provide
Collaborative
Program
Material the
to
and
meperiare
acute toxicity of medical patients
Boston
veillance
effects
in nature.
is
data on the in hospitalized
few
these
anal-
probably that
relatively that
Pharm.D.
fre-
strong
a belief
minor
this
more
other usage
from
and
dominantly of
any
widespread
in
effects
prescribed
than
stems
R. MILLER.
of
Durathe
same
recipients. urea nitrogen among
Clinical
oral
Pharmacology
and
CLINICAL
EFFECTS
OF
MEPERIDINE
TABLE Characteristics
I
of Meperidine
Recipients Per
recipients
Characteristic
Category
of
Primary
(First)
Diagnosis
Neoplastic
43.4
22.6
Cardiovascular
19.7
22.7
Gastrointestinal
5.2
16.6
Pulmonary
6.6
7.3
Symptoms
4.6
7.8
Genitourinary All other
3.3
Days
in
29.6
33.2
10
to
19
35.6
33.9
20
or
more
34.8
32.9
72.1
71.3
14.5
14.6
4.4
5.5
9.0
8.6
than
10
Admission
Value
Less
than to
49
50
or
more
parenteral
of
Urea
Blood
(mg/dl)
Nitrogen
25
25
Unknown
or
not
specified
recipients
and
all
other
moni-
gesics;
about
cipients
patients.
A Meperidine
Oral
was
for pain drug also adjunctive
nostic
liver
used
relief, had
These
adjunctive
ferent
from
analgesic in pain
cardiac
uses
not
doses ingly,
of meperidine are for the remaining
meperidine
usually
therapy
80
per
cent
who
received
were
also
given
other
April
1978
divided
75 and
The average quotient of
the
by
mg was 25 per
the
number
pa-
all recipients. The total amount meperidine given during hospitalization
one
the
oral
strong
dose
recipients; of oral
or two
discussion
excluded. meperidine
drug
for
or mild
between than
varied
100
from
The tending better
pain
The
anal-
rate,
clinical for
first in
less
cent of oral in 2 per cent given
the mg
than
efficacy
relief
measure
to
the
of
dose)
mg
was
cent
30
in
2 Gm or recipients. as judged
was given
efficacy percentage
of of per
more
of mcperidine
of pain,
of is,
last
80 per
100
recipients of parenteral
physicians, when it was that
and about
75
55 per
with
been
the
of parenteral recipients. dose (calculated as
cent
to
and
since
for
of
cent daily
total
given
less
than
About
was
of to
parentcral 8 per
mg
recipients
days
tions recipients
50
oral
dif-
given. Accorddiscussion of
have
of
re-
quite
influencing efficacy, all pareceived meperidine for indicapain
dose of the
of parenteral analgesics.
cent given
the
of factors tients who other
unit cent
cent
other
are only
and
to diag-
75 per
received
or to sur-
uses
tients
exthe use
catheteri-
endoscopy)
gery.
per
almost
prior
(e.g.,
biopsy,
II)
whereas substantial
medication
procedures
zation,
(Table
Therapy
meperidine
clusively parentcral as an
3.9 19.1
17.2
Hospital
Less
tored
Per cent parenteral recipients
cent oral
when by
at-
significantly parentcrally. was
the
failure
of
unsatis181
MILLER
factory for
ratings which
made.
among a
Oral
drug of
meperidine
satisfactory while
all
judgment
in
22
parenteral
exposures
cent
was
judged
un-
of
meperidine
unsatisfactory
in
11 per
At
rated
drug routes
cent.
TABLE Characteristics
Influencing lower
Efficacy
meperidine
(Table unit
III)
doses
failure rate was higher. This was true both physician and patient assessments
recipients, was
JICK
Factors
efficacy
was
per
AND
effectiveness, for of administration,
oral
and parenteral and for patients
II
of Meperidine
Therapy* Per cent
Characteristic
Per cent
oral recipients
parenteral recipients
92.9
52.8
3.0
41.0
Indication Pain Diagnostic
and
preoperative
adjunct
Other
4.1
6.2
Yes
81.8
74.5
No
18.2
25.5
Administration
Unit
Dose
of Other
Analgesics
(mg)
25
75
7.8
100
9.0
8.8
Other
4.2
3.0
Daily
Less 50
than to
50
99
46.4
42.1
34.2
39.7
149
10.5
150
to
199
3.7
9.9 3.8
200
to
249
2.0
1.0
250
or
more
3.2
4.5
100
Dose
(mg)
than to
100
999
30.2
46.9
60.7
46.3
1000
to
1999
6.6
5.0
2000
or
more
2.5
1.8
Physicians’
Judgment
time indications received
Quotient
of Efficacy-Failure portion
of
for
pain
nieperidine of
Percentage of rating of either which no judgment
182
(mg)
to
Less
Only
Dose
25.2
100
Total
*
55.2
75.1
Average
who
7.8
3.9
50
total
dose
divided
unsatisfactory “satisfactory” was made.
this table were by
Ratest pertains
counted number
in of
exposures among or “unsatisfactory”
22.2
to all mneperidine preparing
days
the
between all
recipients;
remaining
first
and
(Irug exposures was made; does
The
10.9
Journal
only
patients
sections. last
dose.
for not
which include
of
Clinical
an
efficacy cases in
Pharmacology
the for of
CLINICAL
EFFECTS
OF
TABLE Influence of Indication, on Efficacy (Failure
MEPERIDINE
III Diagnosis, Rates) of
and Unit Meperidine*
Dose
Failure
rate
(%)
Oral Patients Patients of
with
and
pain
neoplastic
primary given
disease,
recipients
Parenterai recipients
diagnosis unit
of
dose
50
mg
31.8
24.8
75
mg
18.2
15.4
100
mg
13.3
10.3
Patients with pain of other diseases, 50
and primary given unit
diagnosis dose of
mg
19.6
9.4
-
5.1
75mg 100 *
Failure
which
rate an
Since
**
12
and
cancer.
is
was
or
less
without
percentage
with
rates
a primary was
parenterally doses were
declined
from
13.8
to 29 years
old
70 years and to be influenced
nmeaning
affect
per
to 6.2
cent per
central
drug
Adverse
could
not
Reactions
poses adverse if more
Adverse
reactions
3268 1978
parenteral
among
all
exposures
cent
20
for
were
recipients.
minor
oral
attributed
to
of the 366 per cent) For
pur-
with
the
of
were
the
meperidine,
nervous (1.2
per
system cent).
common
system effects depression,
activity,
agitation,
tremor,
were
constipation effects
central
nervous
disorientation, and
or malaise Less frequent
nervous respiratory
re-
effects Most
effects
effects and included feclings, hallucinations,
chosis. Drowsiness commonly observed.
were
adverse parenteral
vomiting; some Neuropsychiatric
most
is some-
disturbances
gastrointestinal
nausea and was observed.
espe-
ones,
recipients
an
adverse the fre-
reactions,
minor
central common
oral
only once; experienced
the most commonly reported actions (2.7 per cent). Among
system bizarre V)
adverse
gastrointestinal
mg
patient
some
of
of
and
100
was counted reaction was
the relatively underestimated.
system.
be determined.
each
or
quency
recipients, were most
rethe of
IV,
75
the most important counted. Therefore,
appear drugs
meperidine unit dose, on dosage
IV
Table reaction than one
Among
doses
in patients
nervous
of
received
by a patient, effect was cially what
drug, increased. unit
meperidine in 16 (4.3 per cent) oral recipients and in 102 (3.1
are not listed.
of
in patients
(Tables
diagnoses
and
in
over. Dose did not by the use of other the
primary
effective
100-mg
Since three fourths of oral cipients received a 50-mg influence of various factors
April
little
Dose
of
exposures
diagnosis less
administered given as age
usage
unsatisfactory
nonneoplastic
have
Influencing
example,
of the
of
made.
with a primary diagnosis of neodisease than in patients with other diagnoses.
With smaller
oral
the
patients
the failure
Factors
that
as
rating
Meperidine
patients plastic primary
For
defined
efficacy
meperidine,
with
5.9
mg
included headache, and
psy-
was also central vertigo, hyperdepression. 183
MILLER
Cardiovascular among nine case
adverse
parenteral instances of
ute).
Other
only
among
(150
adverse
effects
parenteral
minor
injection
site
tivity reactions, Two patients
and were
to meperidine pital.
mg
beats
per
min-
dominal
also
were
seen
additional peared
to the
came appeared
degree
of
daily when
sensi-
they
to
receiving in the
was
hos-
verse
de-
TABLE Reactions
the and
doses
patient
after for four meperidine
receiving days; was
a
100-mg
she became discontinued;
(Table
V).
judged and
dose
did
to Meperidine*
Gastrointestinal
reaction
Oral
recipients
Disturbances
Nausea
or
vomiting
Constipation
Nervous
Central
recipients
System
Disorientation, tions, or
bizarre psychosis
Drowsiness
or
8
(2.2)
27
(0.8)
2
(0.5)
7
(0.2)
2
(0.5)
13
(0.4)
3
(0.8)
8
(0.2)
3
(0.09)
3
(0.09)
Effects feelings,
hallucina-
malaise
Vertigo Respiratory
depression 1
Coma
2
(0.3)
Headache Convulsions
or
Hyperactivity
tremor or
agitation
Depression Cardiovascular
(0.06)
1
(0.03)
9 (0.3) 1
(0.03)
7
(0.2)
4
(0.1)
4
(0.1)
3
(0.09)
2
(0.06)
Injection
Site
Rash,
or
Anuria
Complications
Pruritus,
or
Hives
Diaphoresis Total
184
(0.09)
2
Tachycardia Retention
Figures
(0.09)
3
Effects
Addiction
*
3
Hypotension
Urinary
in
16 columns
are
number
of
patients,
with
per
cent
(4.3) of
Time
recipients Journal
102
(3.1)
in
parentheses.
given
of
Clinical
not. ad-
However, “definitely” in both
Pareuteral Adverse
apde-
agitated pentaz-
IV
Attributed
ab-
craved
patient psychic
relief but placebo had life-threatening
experiences
75 the
had
and
meperidine. Another have developed
to
of
when
nausea
only two of these were related to meperidine,
have
21 hospital;
discontinued, cramps
oeine provided Seven patients
physical
Adverse
after 16 days
pendence
retention and hours, various
dependent
over
drug
in-
diaphoresis. physically
patient
a mild
and
complications,
before
Another
developed
pendence
included and one
and
recipients
cluded six cases of urinary one case of anuria for 24
JICK
occurred
effects
recipients of hypotension
tachyeardia
AND
Pharmacology
in-
CLINICAL
EFFECTS
OF
MEPERIDINE +-4
0
‘a
‘aa
+2
‘a
O
a
4
‘-4
0
5 1-44
Za .0
V
a
a.
0
I
a ‘5
a.
#{149}0
‘a
o a
.0
a a
a
a
.2
j
‘a ‘-4
a
*2
a
0
9 o
a
a.
a
a.
+2
a
#{149}0 ‘4
a
o . *.2
a
9+2
+2
-o
4a
,-.
a+2
a
a
‘4
a
a
a a 0 a
a a
a a
a
a
a
a
.0
0
-ca aa
a P1
a
a. 0
a‘-4
a
8
.
a.0
Ora.b
29
o ‘-4
a.
.5
‘a
a
0
a ‘-
no a o
a.
‘a
0 0 .5
a
bL
*2 .
a
‘-4
to
a a
‘4
C
8
8
bi
O,a
a a
0
0
-
‘a
*2
8
V
-a
a
0
8 a
.8 ‘an
a 0
8
I
-
a
a 5 o a
9 o a.
a
a
a
.0
o
Ca
a
a
0
‘4
‘a
a.
p.
a
a
0
-
a -4)
a
a
0
0
0 a
0 a
a.
0
a.
a 0
P.
a
a a 0 0
U)
a a
a.
I
0 0
‘a 542
-4-
a4
a a
a
a.
.
I-
‘0
a
4-,
m2.
a
a
0 a ‘4
a .
a
‘a 1-47
Sea
.2
.8 a
.9.9 a
a
‘-4
a.Ca
0 *2
a
a
a (-4
‘a a
a
‘4
,
a 0-’a
a
a a
‘4
94’4a
(-
b’a 90
00p.
0
a
0
a
,
+2
‘a
0
am
0
April
1978
I:-
185
MILLER
stances other drugs were implicated. Two patients actions
that
were
ably” related had reactions
thought
to
reactions
depression,
coma,
re-
“prob-
and
three related.
ably
and
Influencing
Adverse
the
(Table
The
frequency
of
to oral creased
and as the
parenteral unit dose,
dose, and frequency
Frequency
Reactions
all
the total dose also increased
of
parenteral
per
cent
who
adverse
reactions
meperidine the average
not
Influencing
the Frequency Oral
Factor Dose
No.
frequency
other
of adverse of
by blood The
who
Similar meperi-
urea
age,
renal
function
nitrogen
mean
body
experienced
Reactions
adverse
Number ARs
Parenter
al recipients
of pts.
Number ARs
with
(%)
No.
14
50
270
0
(0.0)
12
(4.4)
261 1,730
with
4
(1.5) (2.6)
75
25
2
(8.0)
869
28
(3.2)
100
40
4
(10.0)
316
11
(3.5)
Average
Daily
Less 50 100
Dose
than
(mg)
50
to 99 to 149
95
0
(0.0)
166
8
(4.8)
59
5
(8.5)
598 1,564 909
(0.8) (2.4)
29
(3.2)
150
to
199
17
2
(11.8)
200
or
more
22
3
(13.6)
111
2
(1.8)
2,077
42
(2.0)
212
12
(5.7)
1,044
26
(2.5)
21
(16.9)
Total
Dose
100 1000
Days
in
Less
100
8
(11.1)
9
(9.0)
(mg)
than 100 to 999 or more
Less
72
5 38
36
4
(11.1)
124
Hospital than
108
2
(1.9)
1,079
20
(1.9)
10
to
19
130
5
(3.8)
1,101
28
(2.5)
20
or
more
127
11
(8.7)
1,070
40
(3.7)
290
17
(5.9)
2,165
70
(3.2)
1
(1.3)
1,103
19
(1.7)
Concomitant
Yes No
10
Use
of
Other
Analgesics
76
The
Journal
of
Clinical
of reac-
(%)
45
sex, levels
weight
to Meperidine
recipients
was
with
VI of Adverse
1.7 anal-
reactions
correlated
admission.
patients
reac-
while
reaction. for oral
or impairment
as measured
adverse
receive
adverse observed
padur-
(mg)
25
186
of pts.
an
of
analgesics an
not
significantly
on
became larger. The as the duration
did
doses
cent
meperidine,
were
survival,
indaily
TABLE Factors
had
had
prob-
total
per
other
hospitalization
dine. The
VI)
3.2
received
to
this
larger
About
tion gesics findings
Factors
increasingly
who
ing
hypotension.
Unit
reflects
increased;
mepcridine.
tients
respi-
convulsions,
hospitalization
of
be
included
JICK
of
“definitely” adverse
to meperidine, judged “possibly”
Life-threatening ratory
also had
AND
Pharmacology
CLINICAL
tions
was
5.2
cipients
pounds
without
difference
less
than
adverse
was
not
EFFECTS
that
of re-
reactions;
statistically
this
Our data meperidine
of
oral
indicate occur
recipients
parenteral cur more all
that in
of
recipients often at
the
were
in
The
to
meperidine
parenterally
ad-
caused
serious
number
of patients.
disturbances sisting of
commonly
adverse
reported
category
per and
cent), chiefly convomiting. About 1
of parenteral
recipients
had
toward
gastrointestinal
effects.
clear should
why orally provoke a
administered higher frequency
are
effects,
thought
to
meperidine to the received
stomach. somewhat
meperidine
was
cancer patients may partially Among ents,
central common
this
category
(1.1
system per
observed urinary
verse
effects
enteral
bizarre
psychosis) (0.4
were per
cent).
retention, were
seen
only
patients
April
1978
observed
clinically
cipients
meperidinc,
were and
in
serious
13 per
exhigh (0.4
cent
of
In concases of
with
morphine.2
been
noted
pre-
morphine substitutes, the respiration. We significant
respiratory
reported
studies
therefore,
using
we
same
degree
Previous
the have
is given
expected
gesics apparently nomenon.#{176} In of oral
was
cent
of
patients
pain
is this
recipients
mg
than
The
efficacy
quate
dosage
in-
pain.6
Unfortunately,
for
finding. were
a primary This
patients other
medical other
patients.
inpatients strong anal-
a widespread series, about and
is to usually
or
less
60 per
This most
in
about
may
pheper
80 cent
received unit and the average
recipients.
as-
when
reliable
with
than
of and
recipients or less, 150
that
disease.
cancer
severe
parenteral of 50 mg
less
neoplastic
ad-
to
it is consider-
here support this parcnteral meperidine
Undertreatinent with meperidine
dose
and
since
more
shown
parenterally.5
in of
doses,
respiration
orally,
potent
effective
cannot
causes less in experi-
as morphine.4
studies
meperidine
used pain
equianalgcsic
depressed
fre-
par-
respiratory
morphine is with severe
illnesses;
meperidine
less
to have
that mcperidine depression. Indeed,
mental
have
both
relatively effects
have
However, for patients
conclude respiratory
feelings,
definitely
at
effects other depresses
were
diagnosis
respirahypotwo life-
to
Like
reported oral and
verse reactions; they included tory depression, coma, convulsions, tension, and cardiac arrest. Only reactions
and,
occurred
and
differences
viously.3 meperidine
cent had
recipients
data Both
ad-
cribed
These
be
among
they
neuropsychiatric
disturb-
other
of
reactions
reactions) was surprising. we have not observed any
it is given
life-threatening
threatening
cent
adverse trast,
less
recipients.
Seven
per
when
Hypoten-
and
strongly
adverse
frequencies. The of neuropsychiatric
ably
were
most
also
documented,
exception,
for
within
neuropsychiatric
pected frequency
observed
previously
this recipi-
and
one
the
often
effects
cent),
(disorientation,
quently
of and
meperidine
with
and
recipients Since oral
more
the
been
un-
effects
parenteral drug, the difference.
of
have
depression. more often
irritating
oral doses.
prescribed
nervous
hallucinations, sion,
be
were
implicated.
undrug
these
to
Further, lower than explain
is
mediated
known
parenteral
most ances
since
be centrally
is not
It
drugs
depression in only three patients (less than 0.1 per cent of recipients), whereas with morphine nearly 1 per cent of re-
among oral meperiminor gastrointestinal
(2.7 nausea
gastrointestinal
of
and ocNearly
drug most
cent
cent
a small
of adverse reactions dine recipients was
per
oral
whereas
ministered effects
per
in hospital higher doses.
reactions
minor,
3
other
All
adverse reactions about 4 per cent
and
MEPERIDINE
stances
significant.
Discussion
to
OF
of
doses daily 90
per
be
made-
patients
with
severe
we have
no informa187
MILLER
tion on the by monitored pain
severity patients,
relief
cannot
are
be
of
pain and
experienced our data
insufilcient.
certain
AND
on
Therefore,
that
JICK
also
definitely
tions
were
patients
were
analgesics,7 between
to a previous
study
we did not and adverse
age
of strong
Boston
find a correlation reactions. Since
older
patients
received
could tween
have age
obscured an and frequency
lower
doses,
this
association of adverse
bere-
actions. Summary
per
and
cent)
3268
meperidine
received
(12.4
parenterally
more admissions. the most common diagnosis
(43
cipients;
among
cent)
and each)
among
re-
recipients
almost
use
(41
per
preoperative
cent)
lief
of recipients,
in 22 per
enteral
cent
mcperidine
factory effective
in 11 per in patients
nosis
of
tients Miiior
ncoplastic
was
most
actions (2.7
per
commonly
ex-
recipients
had
nervous (1.2
than
in
adverse
life-threatening only
adverse
however,
two
judged and in
definitely related to both instances other
of
Canada
Hospital, Milan; der Freie Uni-
Boston
Collaborative
Program
has
been
Drug supported
Surveilby
a grant
New
par-
these
Zealand,
hospital
unsatis-
system per cent).
actions.
Hospital;
Hospital,
(1
pa-
No. and
1.
2.
mepcridrne, drugs were
Williams
GM-165-38-02), and Health Department.
General
NIGMS
the
Scottish
Grant Home
Miller,
R.
11.:
Drug
surveillance
utilizing
the
R. R.: Analgesics. In Drug Effects Hospitalized Patients, Miller, R. R., and Greenblatt, D. J., Eds. New York, Wiley, 1976, Chapt. 15, pp. 133-164.
Miller, in
rewere
Roger University
epidenmiologic methods: a report from Boston Collaborative Drug Surveillance Program. Amer. J. ffosp. Pharm. 30:584 (1973).
re-
effects Seven
time
(Brown
References
among oral meperidinc recipients cent); among parenteral re-
cipients central were most common
Up-
while
meperi-
primary diagnoses. disturbances were reported
the
physicians pain rerated
disease
‘s
pital, Glasgow; Italy-Desio Gcrmimany-Klinikumn Steglitz The
cent. The drug was less with a primary diag-
with other gastrointestinal
University
of
Ariz.-Arizona Va.-Virginia
ROl GM 23430-01) from the National Institute of General Medical Sciences (NIGMS) and in part by grants from the United States Food and Drug Administration (1 ROl FD00920-01), the Canadian Health Protection Branch, the Israeli Ministry of Health, time Tiadassaim Medical Organization, the Kupat-Holini, Auckland Hospital, Auckland,
Oral
by attending unsatisfactory
Hospital
Center; Tucson, Center; Richmond,
Joseph
lance
as a diagnostic
adjunct.
the Pro-
vei-sit#{228}t Berlin.
diseases common.
prescribed
dine was judged to have provided
188
oral
neoplastic were most
was
or
(93 per cent) for pain relief, the parenteral drug also had sub-
stantial
the
one
disease was of primary
parenteral
meperidine
clusively whereas
received
during
Neoplastic category
per
cardiovascular (23 per cent
cent)
in
Surveillance
London, Ontario; Israel-Hadassah-Hebrew University Hospital, Jerusalem, Beilinson Medical Center, Petah Tiqva, Asaf-Harofe Hospital, Zerifin, and Rambani University Hospital, Haifa; New Zealand-Auckland Hospital, Auckland, and Hutt Hospital, Wellington; Scotland\\reStel.Il Infirmary and Stobhill General fibs-St.
meperidine
per
participated
Drug
University Medical
Commonwealth
patients program,
have
are: Boston, Mass.-Lemuel Shattuck Hospital, Peter Bent Brigham Hospital, Boston City Hospital, Veterans Administration Hospital, Isiassachusetts General Hospital, and University Hospital; Providence, R.I.Roger Williams General Hospital; Syracuse,
Medical
(1.4
and
which
gram
state
orally
related.
Collaborative
N.Y.-State
Of 26,294 hospitalized medical monitored in a drug surveillance
reac-
Acknowledgments Hospitals
In contrast
Oral
dose
Adverse
we
undertreated.
366
implicated.
1.
Kornetsky, C., Hynmphries, 0., and E. V.: Comparison of psychological of certain centrally acting drugs Arch. Neurol. 77:318 (1957).
Time Journal
of Clinical
Evarts, effects in man.
Pharmacology
CLINICAL 4.
5.
Lasagna, L.: The clinical evaluation of morphine and its substitutes as analgesics. Pharmacol. Rev. 16:47 (1964). Eddy, N. B., Halbach, H., and Braenden, 0.
J.:
like
Synthetic effect.
17:569
Marks, treatment
April
1918
substances Clinical
side-effects,
6.
EFFECTS
addiction
with
M.,
and
of medical
Sachar,
Bull. E.
inpatients
cotic
WHO
J.:
Under-
with
nar-
analgesics.
Ann.
Int.
Med.
78:173
(1973). 7.
Bellsville, E.,
J. W., Brown,
and
on pain 217:1835
potency,
(1957).
R.
MEPERIDINE
morphine-
experience: liability.
OF
Reprint Miller veillance
at
tham,
Mass.
Forrest,
relief
B. from
W. H, W.:
Jr.,
Influence
analgesics.
Mifier, of
age
J.A.M.A.
(1971).
requests should the Boston Program, 400
be addressed Collaborative Totten Pond
to: Drug Road,
Dr. SurWal-
02154.
189
