Friday, August 16, 2013

Q: What is an antagonist of Meperidine (Demerol)?

Answer: Naloxone

The narcotic antagonist, naloxone, is a specific antidote against respiratory depression which may result from over-dosage or unusual sensitivity to meperidine. But an antagonist should not be administered in the absence of clinically significant respiratory or cardiovascular depression, and other supportive treatments should be instituted like oxygen, IVF and others.

Remember, in an individual physically dependent on meperidine by chronic use, the administration of the usual dose of a naloxone may precipitate an acute withdrawal syndrome. If an antagonist must be used to treat serious respiratory depression in such patient, it should be administered with extreme care and only one-fifth to one-tenth the usual initial dose administered.

Also, oral Meperidine is a big "no no''! as only 50% of ingested drug escapes first pass metabolism and carries very high risk of delirium, seizure and other side effects via its metabolite normeperidine. Moreover, it is significantly less effective by the oral route.

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