The risk of normeperidine toxicity-the buildup of the meperidine's pharmacologically ac- tive metabolite-is especially high for patients with sickle-cell disease (who often have impaired renal function and cerebrovascular deficits), patients with renal insufficiency, and elderly patients. Without treatment, normeperidine toxicity can lead to death.
Because of the potential for toxic effects, meperidine is no longer a first-line choice for opioid analgesia. Patients with a history of hypersensitivity to morphine may be given meperidine for acute pain, under close monitoring. For patients in sickle-cell crisis, who need high opioid dosages, I.V. morphine is a better choice for pain management.