No More Demerol IV Push???

VickyRN, MSN, DNP, RN · Oct 9, 2005

The hospital has come out with the following protocol concerning demerol usage:

Demerol may be used for the following reasons:

Rigors associated with blood products, amphotericin, etc.

Labor and delivery

Postoperative anesthesia care in the PACU

As part of conscious sedation for procedures

Neuraxial-epidural and intrathecal

Demerol may not be used for the following reasons:

Patient Controlled Analgesia

PO, IV or IM prn for pain control

PO, IV or IM scheduled for pain control

Alternatives/ equivalents to Demerol 100 mg:

Morphine 10 mg

Dilaudid 1 mg

Fentanyl 100 mcg

The hospital has also severely restricted the use of Darvocet-N 100 - because of the excessive amounts of acetominophen per each tablet (650mg) and risk of renal/ hepatic toxicity. Norco (Vicodin) is now being used instead.

z's playa · Oct 9, 2005

Our hospital lists it as "Not recommended IV"

It isn't recommended P.O here only. We do it I.V push all the time here.

different strokes )

Z

harley007 · May 20, 2006

When my identical twin daughter was 12 she was diagnoses with Neurological Lyme’s Disease. Diagnosis = spinal tap with positive culture. At the time the Connecticut insurance limited treatment to 4 weeks. She ended up with a PICC and 10 months of treatment. I used my PCS card to get the weekly $1400.00 of Rocephen for the $30.00 co-pay! I was kindly allowed to rent the needed equipment, dressing sets, etc. from a local Home IV Therapy Agency. She had the same PICC for 10 months and thank goodness the local Invasive Radiologist taught me how to repair the PICC line. Well, my daughter developed gallstones from the Rocephen and let me tell you 12 year olds are not built to handle that type of pain. She used to strip naked and pour cups of cold water over her head as she ran up and down the hallway screaming “Help me please, help me call 911”. By the time I could get her to the ER the worse part would be always be over. So, I put on my Super Monster Mother outfit with the dishtowel cape, and demanded nothing less than a narcotic prescribed so I could give her small amounts of pain relief at home when it was really was needed. She was prescribed a multiuse vial of Demerol. I only gave her 2mg doses IV but, she would seem so strange and irritable after the dose even though it relieved the pain. Then came the night of terror when I could not relive the pain until I increased to dose to 6mg. I ended up giving her a total of 55mg of Demerol over a 10 hour night and boy she was as jumpy and strange as could be. I am not talking about “being high” just weird. Finally it all stopped and the pain just faded away. We had a great sleep and retuned home for her Cholecyctectomy pre-operative appointment. The ultrasound showed that she had passed the stone by herself during that one horrible night. Even though there were no studies I swore that nobody in my family would get that drug again. I was given it for pregnancy produced migraines and it would give me PVC’s. Now I did have Hyperemesis Gravaderium until the day of both my twin and then the 16 month later singleton delivery, so you can imagine what my electrolytes were. Yes, the Demerol did relive my migraines but, the PVC’s were frightening and I couldn’t sleep due to bizarre nightmares.

I am so very, very glad to hear they are taking this scary medication away from such general use. I still do wonder and worry if the Demerol caused my daughter any lasting effects. Thank you for the updated information.

CrohnieToo · May 20, 2006

Well, I've never been on long term pain medication of any kind. (Thank God). I've had IV phenergan many times, both for scopes and in ER years ago, and never had it sting or cause vein problems. I assume from a couple of threads here that it "could" have been the phenergan due to not being diluted properly or being pushed too close to the site instead of further up the line. Years ago in ER (when I went in for the Crohn's) I was usually given demerol and phenergan IM. Didn't get many IVs in ER back the. Fortunately, after a resection the Crohn's was dormant for 20 years and now that it is back it is no where near as nasty as the first time around. But I remember the first time around vividly enough I am not willing to risk Toradol, thank you. I was once given Vicodin for shingles pain. Nausea big time. I opted to suffer and rely on Lidoerm patches.

chase4myheart · May 20, 2006

I fiind all of this information very interesting. I was a patient in the ER Friday due to severe dehydration and nausea from a stomach virus that has been going around. I think that this is the sickest that I have been in the past 10 years. While I was there I was given one vial of phenergan, a shot of zofram, a shot of demerol for the aches and pain that I having throughout my body, and ativan. All of these meds were given by IV route. The ativan was IV pushed due to a reaction they thought that I was having from the phenergan. I couldn't keep my legs still. I was so nauseated and could not lay still on that stretcher. I think that was the most miserable feeling that I've ever had. I'm wondering after reading all of these posts if the restless legs were coming from the demerol that I was given. I don't think that I had ever taken demerol before. Thankfully after receiving the IV fluids and meds, I was better the next day. If the demerol is what caused my side effects, I can certainly see why that it shouldn't be given anymore.

krisssy · May 20, 2006

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 had two abdominal surgeries last year. Both times, I asked to have the IV Push D/C. I was getting agitated, and I had severe muscle twitching and tremors. I did much better on Percoset by mouth. Krisssy

caroladybelle, BSN, RN · May 21, 2006

While I was there I was given one vial of phenergan, a shot of zofram, a shot of demerol for the aches and pain that I having throughout my body, and ativan. All of these meds were given by IV route. The ativan was IV pushed due to a reaction they thought that I was having from the phenergan. I couldn't keep my legs still. I was so nauseated and could not lay still on that stretcher. I think that was the most miserable feeling that I've ever had. I'm wondering after reading all of these posts if the restless legs were coming from the demerol that I was given. I don't think that I had ever taken demerol before.

While (as noted previously) I am not a fan of demerol, phenergan is probably better known for causing the twitches and restlessness, especially after only one dose and given that you probably were already dehydrated.

But as a general rule, zofran is a better antiemetic. And the ativan itself can help with nausea.

psychnurse96 · Nov 24, 2008

I have found all of the posts very interesting on this subject. I work predominantly in psych, but we too, have stopped using Meperidine hcl as a whole. The main reason being what was previously posted-the anxiety, tremors, etc.

There does seem to be a direct link between giving the drug via iv push and the increase in side effects, even with terminally ill patients.

We have found this frustrating though, because this-if used correctly-can be a very effective drug.

I am wondering if this drug will ultimateley be pulled from the shelves.

Please let me know if anyone has any news on this.

CrohnieToo · Nov 24, 2008

Thank God, IV Demeral and Phenergan work miracles for me when I'm upchucking my innards as well as their contents as a consequence of Crohn's disease! May their use never be discontinued! I KNOW they work for me. And the Demerol seems to last longer than the one time I was given morphine.

back2bRN · Nov 25, 2008

Where I work now, don't even have it in the building!!! Let alone give it IV. I can understand the IM, but I really hated giving it IVP, Morphine and Fentanyl are our analgesics of choice for IV.