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

About 6 years ago we had a physician give a conference regarding Demerol being phased out . . . .never happened here.

We give it IV all the time.

steph

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Specializes in ER, ICU, L&D, OR.
i think she may be referring to the current nation-wide shortage of dilaudid.

the way the doctors in my er order no wonder there is a shortage.

ingrown toenail, dilaudid 2 ivp

subungal hematoma, dilaudid 2 ivp

runny nose,,dilaudid 2 ivp

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The way the doctors in my ER order no wonder there is a shortage.

Ingrown toenail, dilaudid 2 IVP

Subungal hematoma, dilaudid 2 IVP

Runny nose,,dilaudid 2 IVP

:rotfl:

steph

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Every drug has its adverse effects and it is not helpful to deem a drug evil when each case is different. In the area I work(PACU) Demerol is used for shivering and pain. Is it a first choice for pain? Not always. Have you ever had a patient with Fentanyl get rigid chest syndrome? Scary stuff. Phenergan is worse than Demerol in my opinion due to the many EPS side effects.

One poster said Demerol made her crazy and therefore it should be banned. Well, Morphine has made many of my patients crazy, but I would keep it around.

Nursing is about evidence based practice and sometimes we need to use the real life experiences of nurses who actually see the effects on REAL patients rather than just blindly listening to ONE research study(possible funded by a competing drug company?)and making rash decisions.It would be a real shame if a medication that has valid uses was banned because of what it might do. Look at Vioxx. How many people are in debilitating pain again because Vioxx MAY cause them heart problems(or may not)

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Just had a frequent flyer last night 75 Dem, 50 Phen IVP q3 (with a portacath that has been in for 5 years, last one was in 6 years)!! Scares me to death to give that much that often -pt demands every 3 on the nose. Our pain mgmt specialist has been talking with her but she claims Morphine allergy - no Tordal r/t some sort of GI (ulcer?) and says Dilaudid doesn't work.

There is trouble on the horizon.

Hospital just instituted a 3 day soft stop on Dem soon to lead to a hard stop requiring different drug. Pts and MDs alike are furious about the policy change. Personally I'm relieved - I haven't seen any adverse effects but I quickly caught on to the addictive quality - and haven't quite worked out how to address pain without aiding the addict in my short career.

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Specializes in Emergency.

demerol ivp is not a good thing........

i worked at a teaching hospital where it was NEVER given.

too addicting, too neurotoxic, and to nephrotoxic. Oftentimes dilaudid was given instead.

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Every drug has its adverse effects and it is not helpful to deem a drug evil when each case is different. In the area I work(PACU) Demerol is used for shivering and pain. Is it a first choice for pain? Not always. Have you ever had a patient with Fentanyl get rigid chest syndrome? Scary stuff. Phenergan is worse than Demerol in my opinion due to the many EPS side effects.

One poster said Demerol made her crazy and therefore it should be banned. Well, Morphine has made many of my patients crazy, but I would keep it around.

Nursing is about evidence based practice and sometimes we need to use the real life experiences of nurses who actually see the effects on REAL patients rather than just blindly listening to ONE research study(possible funded by a competing drug company?)and making rash decisions.It would be a real shame if a medication that has valid uses was banned because of what it might do. Look at Vioxx. How many people are in debilitating pain again because Vioxx MAY cause them heart problems(or may not)

I like your post.

steph

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Demerol should be banned for ER use. I worked at a facility that had a pharm policy stating that opiates are first line pain drugs and Demerol is not. It feels waaaay to good to the folks that seek it. Pts state "I'm allergic to opiates, NSAIDS, Haldol" , but it holds a risk of seizure as well. Why risk seizing a pt when you have opiates. Fentanyl or Dilaudid are great ER drugs and don't cause seizures. Encourage your docs to not use Demerol or refuse to give it. I've told every doc I know that I'm not giving Demerol to a pt (with my rationale) and nobody has ever challenged me.

For the pt allergic to everything....offer RICE.

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I have Crohn's disease. Back in the 70's I thanked God for Demerol in ER many times. Twice in the last 2 years I've ended up in ER. Once I was given morphine and promptly vomited and went into dry heaves the minute the morphine hit my IV. It was the first time I was ever given morphine. The last time I was given Toradol. NEVER AGAIN! I am given Demerol for colonoscopies with no sedation and it works well and I stay awake and alert during the procedure for which I am grateful. Given my experience with morphine and Toradol I am not enthused about anything new they might come up with for pain in ER. I hope they continue to utilize Demerol in ERs!!!

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Specializes in Emergency.

My hospital that I currently work as a travel nurse in just recently told us that the whole system is going Demerol free as of Dec 1. Currently they are in the process of notifying practitioners and staff. The plan is to post information and pamphlets for the patients.

Rj:rolleyes:

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Specializes in OB, M/S, HH, Medical Imaging RN.

I've heard about Demerol IV but were still giving it mixed with Phenergan all the time.

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you all might be interested in this link

http://www.paindr.com/meperidine%20guidelines.rtf

"based upon these observations, it is concluded that there are few circumstances that justify the use of meperidine. therefore, meperidine should only be available within visn-2 as a restricted drug. a template could be developed that will suggest safer, more effective alternatives and equianalgesic dosing guidelines. below are suggested guidelines that could be simplified and developed as a template in cprs." (see above link)

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