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Meperidine (Demerol)

Anesthesia Implications

Updated On: July 10, 2026

Classification:
Synthetic phenylpiperidine opioid, mu-receptor agonist, analgesic
Therapeutic Effects:
Analgesia, anti-shivering, sedation
Time to Onset:

~5 min

Time to Peak Effects:

~10 min

Duration:

2-4 h

Primary Considerations:

Postoperative shivering - Low-dose 12.5-25 mg IV is first-line for shivering (kappa/anti-shivering effect) and the most common current anesthesia use.

Normeperidine toxicity - Active neurotoxic metabolite accumulates with renal impairment or repeated dosing, causing seizures; avoid chronic or high-dose use.

MAOI contraindication - Serotonin syndrome and excitatory reactions (hyperthermia, seizures, death); avoid within 14 days of an MAOI.

Tachycardia - Structurally atropine-like, so unlike other opioids it tends to cause tachycardia rather than bradycardia.

Neuraxial use - Epidural or intrathecal for labor and postoperative analgesia; lipophilic with local anesthetic properties.

Histamine release - May cause hypotension; caution in asthma and hemodynamic instability.

Excessive effect - Naloxone reverses respiratory depression but not normeperidine seizures, which are treated with benzodiazepines.

Drug Interactions - MAOIs (absolute), SSRIs/SNRIs (serotonin syndrome), additive with other CNS depressants.

Pediatric Implications - 0.5-1 mg/kg IV or 1-1.5 mg/kg IM; avoid repeated dosing due to normeperidine.

Obstetric Implications - Crosses the placenta; neonatal respiratory depression peaks 2-3 h after the dose; labor analgesia use is declining.

Contraindications:

Absolute:

MAOI use within 14 days

Relative:

Renal impairment

Seizure disorder

Severe hepatic impairment

Caution:

Elderly

Sickle cell disease

Increased intracranial pressure

IV push dose:

Analgesia: 25-50 mg IV.

Postoperative shivering: 12.5-25 mg IV.

Pediatric: 0.5-1 mg/kg IV.

IM dose:

50-100 mg IM q3-4h; pediatric 1-1.5 mg/kg

Epidural bolus dose:

25-50 mg

Spinal bolus dose:

10-20 mg intrathecal (higher doses ~1 mg/kg produce true spinal anesthesia)

PCA:

Demand dose 10-25 mg, lockout 5-10 min; basal rate generally avoided due to normeperidine accumulation

Method of Action:

Mu-opioid receptor agonist with additional kappa activity and local anesthetic/anticholinergic properties.

Metabolism:

Hepatic (to active normeperidine)

Elimination:

Renal

Reversal:

Naloxone 0.04-0.4 mg IV titrated (mu-opioid antagonist)

Additional Notes:

DEA Schedule II. Commonly supplied as 25, 50, 75, and 100 mg/mL.

Reference

Nagelhout JJ, Elisha S. Nurse Anesthesia. 7th ed. Elsevier; 2023.Opioids
Lopez MB. Postanaesthetic shivering: from pathophysiology to prevention. Rom J Anaesth Intensive Care. 2021.
Miller's Anesthesia. 9th ed. Elsevier; 2021.Opioid pharmacology