Overview
| Trade Names: | Centralgin; Demarol; Demerol; Dispadol; Dolantin; Dolcontral; Dolosal; Dolsin; Isonipecaine; Lidol; Lydol; Meperidine Hcl; Meperidol; Methyl phenylpiperidine carbonic acid ethyl ester; Nemerol; Operidine; Petantin; Pethanol; Pethidin; Pethidine; Pethidineter; Petydyna; Phetidine; Piperosal; Pipersal; Piridosal |
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| PharmGKB Accession Id: | PA450369 |
Description
A narcotic analgesic that can be used for the relief of most types of moderate to severe pain, including postoperative pain and the pain of labor. Prolonged use may lead to dependence of the morphine type; withdrawal symptoms appear more rapidly than with morphine and are of shorter duration. PubChem (source: Drug Bank)
Indication
Used to control moderate to severe pain. (source: Drug Bank)
ATC Therapeutic Category
- N02AB:Phenylpiperidine derivatives
Pharmacology, Interactions, and Contraindications
Mechanism Of Action
Meperidine is primarily a kappa-opiate receptor agonist and also has local anesthetic effects. Meperidine has more affinity for the kappa-receptor than morphine. Opiate receptors are coupled with G-protein receptors and function as both positive and negative regulators of synaptic transmission via G-proteins that activate effector proteins. Binding of the opiate stimulates the exchange of GTP for GDP on the G-protein complex. As the effector system is adenylate cyclase and cAMP located at the inner surface of the plasma membrane, opioids decrease intracellular cAMP by inhibiting adenylate cyclase. Subsequently, the release of nociceptive neurotransmitters such as substance P, GABA, dopamine, acetylcholine and noradrenaline is inhibited. Opioids also inhibit the release of vasopressin, somatostatin, insulin and glucagon. Meperidine's analgesic activity is, most likely, due to its conversion to morphine. Opioids close N-type voltage-operated calcium channels (OP2-receptor agonist) and open calcium-dependent inwardly rectifying potassium channels (OP3 and OP1 receptor agonist). This results in hyperpolarization and reduced neuronal excitability. (source: Drug Bank)
Pharmacology
Meperidine is a synthetic opiate agonist belonging to the phenylpiperidine class. Meperidine may produce less smooth muscle spasm, constipation, and depression of the cough reflex than equivalent doses of morphine. The onset of action is lightly more rapid than with morphine, and the duration of action is slightly shorter. The chemical structure of meperidine is similar to local anesthetics. Meperidine is recommended for relief of moderate to severe acute pain and has the unique ability to interrupt postoperative shivering and shaking chills induced by amphotericin B. Meperidine has also been used for intravenous regional anesthesia, peripheral nerve blocks and intraarticular, epidural and spinal analgesia. Meperidine is considered a second-line agent for the treatment of acute pain. (source: Drug Bank)
Food Interactions
Take without regard to meals. Avoid alcohol. (source: Drug Bank)
Absorption, Distribution, Metabolism, Elimination & Toxicity
Biotransformation
Meperidine is metabolized in the liver by hydrolysis to meperidinic acid followed by partial conjugation with glucuronic acid. Meperidine also undergoes N-demethylation to normeperidine, which then undergoes hydrolysis and partial conjugation. Normeperidine is about half as potent as meperidine, but it has twice the CNS stimulation effects. (source: Drug Bank)
Protein Binding
65-75% (source: Drug Bank)
Absorption
Oral bioavailability is 50-60% in patients with normal hepatic function. (source: Drug Bank)
Isomeric SMILES Code:
CCOC(=O)C1(CCN(CC1)C)C2=CC=CC=C2 (source: Drug Bank)
The following genes are in curated knowledge about this drug.
| Gene | Relationship | Evidence | |
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CYP2B6 |
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CYP2C19 |
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CYP3A |
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CYP3A4 |
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CYP3A5 |
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UGT1A4 |
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A list of non-curated publications that mention this drug along with other genes is available.
Drug Targets
| Gene | Description | |
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| GRIN3A |
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(source: Drug Bank) |
| OPRK1 |
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(source: Drug Bank) |
A list of non-curated publications that mention this drug along with other drugs is available.
Drug Interactions
| Drug | Description | |
|---|---|---|
| chlorpromazine |
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Increased sedation and hypotension (source: Drug Bank) |
| cimetidine |
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Cimetidine increases the effect of the narcotic (source: Drug Bank) |
| donepezil |
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Possible antagonism of action (source: Drug Bank) |
| galantamine |
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Possible antagonism of action (source: Drug Bank) |
| isocarboxazid |
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Potentially fatal adverse effects (source: Drug Bank) |
| isoniazid |
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Possible episodes of hypotension (source: Drug Bank) |
| moclobemide |
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Increased CNS toxicity (can cause death) (source: Drug Bank) |
| naltrexone |
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Naltrexone may precipitate a withdrawal syndrome in opioid-dependent individual (source: Drug Bank) |
| phenelzine |
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Potentially fatal adverse effects (source: Drug Bank) |
| ritonavir |
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Ritonavir increases the levels of analgesic (source: Drug Bank) |
| rivastigmine |
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Possible antagonism of action (source: Drug Bank) |
| selegiline |
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Potentially fatal adverse effects (source: Drug Bank) |
| sibutramine |
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Possible serotoninergic syndrome (source: Drug Bank) |
| tranylcypromine |
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Potentially fatal adverse effects (source: Drug Bank) |
Curated Information
The following diseases are in curated knowledge about this drug.
| Disease | Relationship | Evidence | |
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Hallucinations |
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Seizures |
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Serotonin Syndrome |
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Non-Curated Information
A list of non-curated publications that mention this drug along with other diseases is available.
Curated Phenotype Datasets
These datasets are sorted alphabetically by title.
- Meperidine N-demethylation by endogenous CYP450 enzymes in human liver microsomes




- FA
Submitted by Mark J. Ratain, MD involving CYP2B6, CYP2C19, CYP3A4, , meperidine, mephenytoin and midazolam - Meperidine N-demethylation by human CYP450 isoforms




- FA
Submitted by Mark J. Ratain, MD involving CYP2B6, CYP2C18, CYP2C19, CYP2C8, CYP2C9, CYP2D6, CYP3A4, CYP3A5, and meperidine
Additional Datasets
These datasets are minimally curated and are sorted alphabetically by title.
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LinkOuts
Common Searches
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Non-Curated Publications
A list of non-curated publications that mention this drug is available.
