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

VickyRN -

not only the neuro-toxic issues, but also the fact that there are better more effective analgesic agents available is why my hospital does not even have demerol available in our pharmacy or on our current formulary. It has been that way in the Jefferson Health System for at least the past three years.

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At my Hospital we no longer use demerol in any form.

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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

Our Emergency dept. physicians have eliminiated all use of Demerol for pain based on EBP information.

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It's no longer our first line of defense in pain relief based on the studies mentioned. However, when a patient has a morphine allery or ineffective pain relief some docs will order it.

Honestly in all my years of giving it IV I never have seen any said side effects, and we used to give it a lot. I have to trust the research however.

I agree. In 30 years of using IV Demerol, I found it to be quite effective for short term post-op pain relief for most patients. We still use IV Demerol now but less frequently than in the past, and never for elderly patients.

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Hey Y'all

Had my 1st colonoscopy a couple of weeks ago. The fun things you do when your turning 60!! Had my first versed. Don't recall EVER having had any benzo.

Wow. For 30 minutes I didn't think about sex at ALL!!

Papaw John

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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

:angryfire Each time I received Demerol, ( once in labor and again soon afterwards for surgery) I went absolutely CRAZY!!! !! two years went by and I had surgery again and somehow it got overlooked that I was NOT to have Dmerol and got shot up with 100mgs .. :nono: :mad: .long story short...I punched a Dr tried to choke a nurse and when I came to, I was in 4 point restraints!!!! :imbar :scrying:

Demerol is a HORRIBLE DRUG!!! it should be investigated and removed from the Market..I know very few people and or patients that ever had a good exp with that drug... :madface:

This is just my :twocents: :rolleyes:

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I received Demerol IM post-op from ankle surgery. I hated it. It only worked for an hour or two, but could only be given every four hours. I had IV access, by the way. I was in pain all night and all the next day. My nurses called the doctor 4 times to change my medication and all he would do is up the dose until the final call when the nurse said "look, she's going home in a few hours, can't we switch her to something PO." He gave me Tylox and it worked! When I went home he gave me lortab, even though I asked for tylox. It didn't work so I asked for Tylox again, and he gave me a prescription for ....Demerol and phenergan. It caused muscle twitches, mood swings and made me MEAN. AND it didn't work any better than the lortab:madface: . Not only will I never use that ortho doc again, I will ask that I not receive demerol again.

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This is all very interesting to me...have been an ER nurse for 4 years now, and we give Demerol all the time! I would say in the last year or so it hasn't been used as much, but some docs will only give that med for pain control (unless there is an allergy of course). I would say we give it IM more than IV (and we definitely have some people who I think are addicted, one who gets 200mg with 50-100 mg Phenergan almost every 2-3 days for migraines!)...but I'm curious as to why some hospitals are completely taking it out of their formulary and others are not. I've never personally seen any of the really bad side effects that have been mentioned in this thread. Just drowsiness, and it not really working in some patients. Dilaudid is the one everyone asks for now. But this will make me think about it the next time an MD orders it, and ask them what they think about this research. By the way, we still stock 50mg, 75mg and 100mg vials in our narc drawer consistently!

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I work at a large teaching hospital. It is still common in my practice to give Demerol IV push. From my experience, however, I don't know that it is any safer (ie. fewer neurologic sequelae) to give it other than by IV push. I recall a case a few years ago where an older teen was receiving Demerol 150 mg. PO, Q3 hours PRN. I no longer recall how many doses she received, but I don't think that she had been on this regimen very long when she began to seize. I believe that the cause of the seizures was thought to be the build up of the neurotoxic metabolite, normeperidine.

Just my $.02 worth.

David

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This is all very interesting to me...have been an ER nurse for 4 years now, and we give Demerol all the time! I would say in the last year or so it hasn't been used as much, but some docs will only give that med for pain control (unless there is an allergy of course). I would say we give it IM more than IV (and we definitely have some people who I think are addicted, one who gets 200mg with 50-100 mg Phenergan almost every 2-3 days for migraines!)...but I'm curious as to why some hospitals are completely taking it out of their formulary and others are not. I've never personally seen any of the really bad side effects that have been mentioned in this thread. Just drowsiness, and it not really working in some patients. Dilaudid is the one everyone asks for now. But this will make me think about it the next time an MD orders it, and ask them what they think about this research. By the way, we still stock 50mg, 75mg and 100mg vials in our narc drawer consistently!

50mg-100mg Demerol with a 25mg-50mg of Vistaril used to be given ALOT both pre-op and post-op and used alot in the ER's...when did they stop with the Vistaril and change to Phenergan???

Dilaudid is abused big time...I think its because its so fast acting but also shortly lived...1-2mg IVP Q1-2hrs PRN is not uncommon for a order from some Drs.... We had a ortho patient who requested it around the clock and because the order was there, some nurses just gave it without question...one day I got "nosey" LOL and asked..."Can ya tell me where your pain is located at this moment and on a scale of 1-10 how intense is the pain?" The patient NEVER once told me the pain was in her knee ( she had a partial knee replacement two weeks earlier and was in for Rehab) ...she gave me " Well i have a headache and cramps" Cramps??? Headache??? No history of migraines...just a headache....when the Dr came in I discussed this with him and reviewed how much she was using...Well we prepared for any withdraw symptons and DC'd the med..giving her one percocet every 6 hrs PRN....Guess she knew we were finailly on to her cause she never complained...

I guess the point I am trying to make here is, No matter what the drug of choice may be, percocet, demerol, dilaudid, lortab etc...just because they have the order, we as nurses DO have an OBLIGATION to our pts well being..No we can never assume the level of pain a patient, but we most certainly can keep an eye of the pattern use and we do have a right to contact the Dr... I refuse to become an enabler...

Don't get me wrong, I am totally for pain management...its a part of the pts healing process...but I do ask the patient....and I am sorry... some will just ask for it because they know they can have it...

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Specializes in Psych, M/S, Ortho, Float..

Until recently I worked mostly in Ortho. I occassionally floated down to the ER. One night I had a woman with pelvic pain, NYD, but not preggers. Demerol 50 mg IVP. I diluted and pushed it slow. Pt's eyes rolled back, and she started to twitch. Completely unresponsive for 5 minutes. Scared the begebers out of me. She came to with no further adverse reactions, but that was the last time I pushed Demerol. After that, I always piggybacked it and it went in slow.

I had pushed it slow, but not slow enough.

I now work psych so it is a non-issue at this point, but I will never give Demerol IVP again if I can possibly avoid it.

On Ortho, I found that they had been getting away from Demerol for the past 2 years. IV nacs (morph/dilaudid) for the first day or 2, then to po (Percocet/tylenol#3). New regime seems to work better. By day 4, pts who were doing well were switched to tylenol plain and Ibuprophen.

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Specializes in Critical Care, ER.

My facility loves Fentanyl which is used about 90% of the time. Then comes MSO4, then the lightweights. I haven't given Demerol IV or IM at all in the 13 months that I have been working SICU.

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