No More Demerol IV Push???

perfectbluebuildings, BSN, RN · Sep 26, 2005

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

So are we... mostly with kids with GI problems, seems like. We use a syringe pump and put it in over at least 15 minutes.

chip193 · Sep 26, 2005

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

Demerol is actually off formulary in my hospital. Of course, this simply means that we need to fill out another silly form when we give it - there's still 25 mg and 100 mg preloads in the narc locker!

Chip

caroladybelle, BSN, RN · Sep 26, 2005

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.
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!!!

Many many people have nausea with morphine IV on the initial dose/s. This goes away with later dosing. Patients should be given an antiemetic with it, but MDs rarely think to prescribe one.

But Demerol is very dangerous drug, no matter where it is given, ER or otherwise and is being phased out in most places. Drugs such as Dilaudid, morphine, fentanyl, stadol, etc. are being used more often.

J_W, DNP, APRN, CNS · Sep 26, 2005

I work in the PACU and we use it IV for shivering...It works wonders on post op shivering...It does have some bad side effects because of the metabolite...

rntg · Sep 26, 2005

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!!!

Just wondering what your negative experience with Toradol was. We give it all the time on our med surg floor, either as an antiinflammtory or pain adjunctive. Most of the patients tell us it really helps the pain, especially in the post op hysterectomy patients. It is usually used only for a few doses, but really seems to help to get pain under control. Of course, I always dilute it first, before giving IV as the patients say it really burns.

TinyNurse, RN · Sep 29, 2005

difficult to metabolize, risk of seizures................ rarely given in ER. ( in nashville)

VickyRN, MSN, DNP, RN · Sep 29, 2005

Just wondering what your negative experience with Toradol was. We give it all the time on our med surg floor, either as an antiinflammtory or pain adjunctive. Most of the patients tell us it really helps the pain, especially in the post op hysterectomy patients. It is usually used only for a few doses, but really seems to help to get pain under control. Of course, I always dilute it first, before giving IV as the patients say it really burns.

Personally, I've had no bad experiences with Toradol. It is a great antiinflammatory post-op medication. Often, it will relieve post-op pain better than morphine. But this drug reportedly can be very dangerous - can cause GI bleeds and renal damage, and requires close monitoring. Toradol should never be used more than 5 consecutive days. Also, creatinine should be checked before and during therapy, as well as H & H.

CrohnieToo · Sep 29, 2005

I have lived with Crohn's disease for 30 years. It is a struggle to achieve symptomatic remission much less true remission for any length of time. Crohn's can occur along the GI tract anywhere from the mouth to the orifice. The risk of GI bleed with Toradol which is an NSAID is just not worth the risk and should have been contraindicated in a known CD patient. I received Toradol in a PIV "push" (possibly undiluted) at the first "port" above the insertion site and experienced scleritis and superficial thrombophlebitis from wrist to forearm and a DVT in the axillary vein of that arm.

teeituptom, BSN, RN · Sep 29, 2005

I think this is all funny, I mean we have used demerol for decades now. And all of a sudden its now deemed unsafe. The only problems Ive ever seen is using way too much of it.

Or maybe its all these other psychotropic drus and antianxiety drugs and anti depression meds and whatever else that everyone seems to be taking nowadays is causing a reaction to occur.

StokoRN · Sep 30, 2005

How the times do change !

Many years ago, when I worked in ICUs, Demerol was a very commonly used drug. I do not recall there being so many problems with it. Most of our patients were relatively short stay. Maybe the were not on it long enough to develop toxicity.

A few years ago I worked in a PACU in a large university hospital. There, Demerol was reserved for the treatment of severe post anesthesia shivering. Fentanyl was the drug of choice for post op pain management . The pharmacist there said that Demerol was off formulary due to it's neuro-toxicity, high addiction rate, and the fact that there were several more effective & safer narcotic analgesics.

Recently, I have worked in EDs & PACUs in a community hospital setting. It appears to me that Demerol is fairly popular in the ED and less so in the PACU.

One of the rationalizations for it's use in the ED is that patients won't be on it long enough to develop toxicity or addiction. I also see patients in the Ed that insist that Demerol is the ONLY drug that works for them. I assume it is due to the "buzz" they get.

Incidently, I see a growing trend in ED, & post op hospital pain management to avoid IM injections. The trend is to use IV medications. The feeling is that repeted IM injections is barbaric and causes much more pain than is necessary and that small amounts of IV injections, more often, allows better pain control with smaller doses of narcotics.

"The miracle is not that I finished, but that I had the courage to start"

pghfoxfan · Sep 30, 2005

Our hospital lists it as "Not recommended IV"

caroladybelle, BSN, RN · Oct 3, 2005

The risk of GI bleed with Toradol which is an NSAID is just not worth the risk and should have been contraindicated in a known CD patient.

Actually, as an IBD patient myself, I would rather have the Toradol. As I have developed the joint problems that accompany the longterm disease state, NSAIDs are a G-dsend for me and many IBDers, because their antiinflammatory effects attack the source of the pain better without the more serious side effects of prednisone (also a more serious risk factor for GI bleeds but still used frequently in IBD patients). And with proper usage and monitoring, they are less dangerous than using demerol (which also should require proper monitoring). With careful use, they allow me to live a more productive existance.

I have an allergy (anaphylactic - documented respiratory compromise) to Tylenol and do not like to deal with the "dazed and confusedness" of narcotics.

That said there are many much safer narcotics than demerol out there. Because dealing with the metabolites of demerol is also not worth the risk.

In addition, didn't you say that you got IV Phernergan, also...a well known irritant...that in many places is contraindicated for IV use, for that very reason? There are many other, better, less toxic alternatives that cause less sedation, that do not cause the venous irritation that accompanies IV phenergan use.

In addition, these days, demerol is being considered contraindicated for most conditions, as one cannot predict when neurotoxicity may occur. There is rarely any warning...as when people enter the medical system, they are presumably ill and that wll affect how the drug acts in the system.