No More Demerol IV Push???

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In our school's teaching hospital, Demerol can no longer be given IV push (only IM). Is this a new trend? Has anyone heard of this? The rationale is that the metabolic breakdown product of meperidine (normeperidine) is neurotoxic and can cause agitation, irritability, nervousness, tremors, muscle twitching, myoclonus and seizures.

http://ruralnet.marshall.edu/pain/demerol.htm

http://www.hospicecares.org/Pharmacy%20Newsletter/Spring2002Pharmacy.htm

In our school's teaching hospital, Demerol can no longer be given IV push (only IM). Is this a new trend? Has anyone heard of this? The rationale is that the metabolic breakdown product of meperidine (normeperidine) is neurotoxic and can cause agitation, irritability, nervousness, tremors, muscle twitching, myoclonus and seizures.

http://ruralnet.marshall.edu/pain/demerol.htm

http://www.hospicecares.org/Pharmacy%20Newsletter/Spring2002Pharmacy.htm

I have heard that The reason for not using Demerol is due to the fact that the Metabolites that cuase ill effects stay in the body longer than the medication controls pain, causing toxic build up.

I have also heard that there are hospitals that are "Meperidine free zones" for these reasons.

I work on an Oncology unit where we never use demerol for oncology patients. WE do get medical and surgical patients on demerol IV and /or IM. In my 27 year experience as an RN I've foun Demerol tio be one of the most addictive drugs there is. We end up getting patients in and out every couple months for a lifetime with pain that ONLY Demerol can help.

I think there are much better and safer options, like morphine with less toxic build up and not as addictive.

in my last hospital in australia - a major teaching facility - we weren't allowed to give any IV narcotics - ever - everything was given IM - although they did use PCAs

just for interest sake - I have been a nurse for almost 10 years - usually had no problems with demerol - however one time with a patient who was receiving high doses IV over a long period of time did seize and stop breathing and have to be resuscitated - they blamed it on the demerol - patient had no history of seizure

We have used demerol for rigors or if there is another contraindication for use of an alternative medication. We have 25 mg vials in Pyxis, but any larger amounts are kept in the narcotic vault in Pharmacy.

In our school's teaching hospital, Demerol can no longer be given IV push (only IM). Is this a new trend? Has anyone heard of this? The rationale is that the metabolic breakdown product of meperidine (normeperidine) is neurotoxic and can cause agitation, irritability, nervousness, tremors, muscle twitching, myoclonus and seizures.

http://ruralnet.marshall.edu/pain/demerol.htm

http://www.hospicecares.org/Pharmacy%20Newsletter/Spring2002Pharmacy.htm

Vicky,

Demerol will break down the same way whether it is IV or IM. Demerol is not the drug of choice for the reasons you mentioned as well as - why inflict pain (IM injection:madface: ) to relieve pain when there are so many other choices. We still have some MD's that order it and if we can't get them to change the order to a different pain med the patient gets it.

:sniff: LK

We give Demerol IV like it is going out of style. Good to know.

Specializes in Med-Surg, OB/GYN, L/D, NBN.

LOL... At our hospital, too. In fact, most every patient that comes in with anything related to pain gets Demerol... if not IV push, then IM. However, if they happen to have an IV, then they want it IV push. All our SC patients get it frequently. Never seen any neuro problems, though. I mentioned something to one of our doctors the other day about this discussion thread about some hospitals not giving it IV, or at all, anymore. He thought that was interesting...

We still give IV demerol in the ED. Ours is the only pyxis that contains demerol, though. The floors aren't allowed to use it except for pt allergies, and then they have to request it from pharmacy.

Specializes in ER, ICU, L&D, OR.

We still use demerol also. But my thought is what is going to happen to all those poor little frequent flyers who come saying they can only take demerol. That must be such a dissapointment for them. I feel so sorry for them.

In our school's teaching hospital, Demerol can no longer be given IV push (only IM). Is this a new trend? Has anyone heard of this? The rationale is that the metabolic breakdown product of meperidine (normeperidine) is neurotoxic and can cause agitation, irritability, nervousness, tremors, muscle twitching, myoclonus and seizures.

http://ruralnet.marshall.edu/pain/demerol.htm

http://www.hospicecares.org/Pharmacy%20Newsletter/Spring2002Pharmacy.htm

In Florida, they basically did away with Demerol. There was literature passed around and for the central Florida area, the only exceptions were in PACU and OR. They posted charts that gave alternatives and comparable dosages.

What I found most interesting is that Dilaudid 2mg is equal to Morphine 10mg. Now that I am in Georgia, they are scared to give Morphine 4 mg, or even Dilaudid at all. Among many other issues, they were clueless to the debate on Demerol (4 of the hospitals thus far).

Coming from Tennessee, I found that the days of giving Demerol 100mg every 4 hours, Dilaudid 2mg every 4 hours, and Morphine 5-10mg, we got the patients up and out faster. Making sure we weaned them by the night before discharge.

Peace and love...nothing less! The Lady

Specializes in Vents, Telemetry, Home Care, Home infusion.

If Dilaudid not in stock, what drug do you give for rigors associated with IV Vancomycin?

If Dilaudid not in stock, what drug do you give for rigors associated with IV Vancomycin?

I've never worked at a hospital thus far that Dilaudid was not in stock. Out of 15 years I have only seen 1 reaction from Vancomycin that required a medication atagonist. With C-Diff on the rise, we are using Vancomycin like it is the new Penicillin.

Specializes in ER, ICU, Infusion, peds, informatics.
i've never worked at a hospital thus far that dilaudid was not in stock. out of 15 years i have only seen 1 reaction from vancomycin that required a medication atagonist. with c-diff on the rise, we are using vancomycin like it is the new penicillin.

i think she may be referring to the current nation-wide shortage of dilaudid.

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