Demerol (C 15 H 21 NO 2 • M.W. 321.8 ) is the trade name for meperidine hydrocholoride, manufactured by Sanofi-Synthelabo, Inc. This medication is an opiate agonist, and a Schedule II controlled substance with a high abuse liability. Meperidine is completely synthetic and can be produced with dichlorodiethyl methylamine and benzyl cyanide.
Meperidine hydrochloride consists of ethyl 1-methyl-4-phenylisonipecotate hydrochloride, a white crystalline substance. It is readily soluble in water and has a neutral reaction and slightly bitter taste. On the street, Demerol is referred to as Demmie(s).
Demerol was introduced as a potent analgesic in the 1930s and was originally found to be useful for muscle spasms. With the discovery of its analgesic properties, it has since been used almost exclusively for the relief of moderate to severe pain.
Demerol produces similar, though not identical effects to morphine. Most notably, meperidine has a shorter duration of action and reduced antitussive and antidiarrheal actions. Several analogues of meperidine have been secretly produced with one memorable analogue with a neurotoxic by-product that produced irreversible Parkinsonism.
The principal actions of therapeutic value in Demerol are analgesia and sedation. Demerol is a narcotic analgesic with effects similar to morphine. Currently, Demerol is used for the relief of moderate to severe pain, most commonly in obstetrics and post-operative conditions. A unique characteristic to Demerol over its opiate family members is its ability to interrupt postoperative shivering and shaking chills induced by amphotericin B.
Demerol comes in both tablet and liquid form for oral administration. It is usually is taken every 3-4 hours as needed. The drug can also be administered by injection into a large muscle or added to an intravenous fluid. Unlike most other opiates, Demerol has a short duration of action of only 2 to 3 hours. The standard dosing schedule results in serum levels below the concentration required for pain relief for most of the dosing interval.
Demerol is typically found as a single product, with few combination products. One frequently found combination product is acetaminophen in Demerol APAP.
When abused, Demerol is taken orally, injected and snorted. Never increase the amount or frequency of your dose without your doctor’s approval, or take this drug for any reason other than the one prescribed.
Despite being structurally distinct from morphine and related opiates, Demerol’s effects on opiate receptors are similar to those of morphine. Demerol alters the perception of pain in the spinal cord and CNS but has no effect on afferent nerve endings. Although the exact physiologic action of opiates is not known, stimulation of opiate receptors ultimately reduces neurotransmitter release.
The effects of Demerol are felt 10-15 minutes after ingestion and typically last anywhere from 2-4 hours. Demerol’s effects are very similar to morphine, with sedation, respiratory depression and euphoria less intense than that of morphine. While nausea and vomiting are fairly common with oral use, it is less likely when administered via injection. Users of Demerol usually experience euphoria because the medication triggers the brain’s pleasure centers while it blocks pain.
The most frequent adverse reactions associated with Demerol use are: lightheadedness, dizziness, sedation, nausea, vomiting, and sweating. Less common side effects include: euphoria, dysphoria, weakness, headache, agitation, tremor, uncoordinated muscle movements, severe convulsions, transient hallucinations, disorientation, visual disturbances, dry mouth, constipation, biliary tract spasm, flushing of the face, tachycardia, bradycardia, palpitation, hypotension, syncope, urinary retention, pruritus, urticaria, and other skin rashes.
If you habitually take Demerol in doses higher than recommended, or if you take it over a long period of time, you may eventually become dependent on the drug and suffer from withdrawal symptoms if you abruptly stop it.
The major hazard of Demerol is respiratory depression. To a lesser degree, other risks are circulatory depression; respiratory arrest, shock, and cardiac arrest.
Do not take Demerol without Telling your Doctor:
· if you have hypersensitivity to Demerol.
· if you have used monoamine oxidase (MAO) inhibitors during the previous 14 days.
More serious reactions include hyperexcitability, convulsions, tachycardia, hyperpyrexia, and hypertension. Although it is not known if other narcotics are free of the risk of such side effects, most reported reactions have occurred with Demerol.
It is especially important to check with your doctor before combining Demerol with the following:
· Other narcotic analgesics
· General anesthetics
· Sedative-hypnotics (including barbiturates)
· Tricyclic antidepressants
· Other CNS depressants, including alcohol. Respiratory depression, hypotension, and profound sedation or coma may result.
Special warnings about Demerol:
* Demerol should be used with caution in patients with atrial flutter and other supraventricular tachycardias.
* Demerol may aggravate preexisting convulsion disorders. Convulsions may occur in individuals without such history if the dosage is escalated above recommended levels.
* Demerol should be administered with extreme caution in the elderly or debilitated, and those with severe impairment of hepatic or renal function, hypothyroidism, Addison’s disease, and prostatic hypertrophy or urethral stricture.
* Demerol may interfere with the diagnosis and treatment of abdominal conditions.
Demerol overdose presents with bluish colored skin; cold and clammy skin; coma or extreme sleepiness; limp, weak muscles; low blood pressure; slow heartbeat; troubled or slowed breathing. In the case of overdose, immediate medical attention is required.
Demerol can produce drug dependence akin to morphine, giving it a high abuse potential. It should be prescribed and administered with the same degree of caution appropriate to the use of morphine.
The possibility of tolerance and psychological dependence, particularly with excessive use, should be considered. If psychological dependence occurs, the medication should be discontinued. Abrupt cessation following prolonged high dosage administration may result in extreme fatigue and mental depression. A slower, physician supervised taper off the drug is highly recommended.
Signs of Demerol dependency:
· A strong desire or need to continue taking the medicine.
· A need to increase the dose to maintain the effects of the medicine.
· Withdrawal syndrome occurring after the medicine is stopped.
Opiate agonist drugs such as Demerol can quickly induce “tolerance.” Tolerance is a diminished response to a drug that develops over days, weeks, or months. It is the effect of cellular adaptive changes or enhanced drug metabolism from extended use of a medication.
If you abuse Demerol, you will likely find that the dose that has worked for you is suddenly inadequate, necessitating an increase. However, if you increase the dose, you will soon become tolerant to the higher dose, leading to the vicious circle of addiction. This is why it is so important that your physician help you monitor or discontinue this medication in a careful and safe manner to avoid severe withdrawal symptoms.
The length and severity of Demerol withdrawal is directly related to how much and how often the drug was used. Generally speaking, you may experience withdrawal symptoms if you stop taking it suddenly after several weeks of continuous use.
You should always consult with your physician before stopping this medication.
Obviously, the severity of withdrawal symptoms experienced is directly related to the amount of Demerol taken and the length of time over which it has been taken. Generally speaking, “cold turkey” quitting of this medication is not recommended. If you use Demerol regularly and wish to stop taking this medication, consult first with your physician.
“Cold turkey” withdrawal symptoms can occur four to five hours after the last dose and usually lasts 7 to 10 days. Demerol withdrawal symptoms include but are not limited to: severe anxiety, insomnia, profuse sweating, muscle spasms, chills, shivering and tremors.
Long term Demerol users should taper off the medication slowly under a knowledgeable physician’s care, or, enter a detox center for 24/7 treatment. With a moderate to severe addiction from relatively long term use, an in patient detox in a hospital or medical supervised setting is highly recommended for its multi- disciplinary approach. Dependence resulting from even a few weeks of regular use can usually be handled under a physician’s supervision with minimal discomfort. Treatment will ultimately depend on the degree of addiction.
However a person chooses to free themselves from the clutches of a drug, there is one constant each needs: Support. Narcotics Anonymous remains a successful choice for many addicts, with world-wide availability. The “information age” has produced numerous on line support forums, popular with many recovering addicts, useful to some addicts as their sole means of support and for others, as adjunct therapy. Drug addiction is treatable, with help out there for everyone.