Actor Heath Ledger dead at 28; pills near

[Guest zipperzone]

RE: What About The Masseuse?

 

>I would also add that meperidine has some uniquely dangerous

>and often even fatal interactions with multiple medications

>and alcohol. In fact, the sister of a good friend of mine

>died after it was given to her by an ignorant ER doctor (for

>headaches, which is a particularly big no-no with this

>medication). I think I may have prescribed it once or twice

>in the last 15 years, and both of those times with

>hospitalized patients.

 

I did not mean to give the impression that my MD prescribes Demerol for carrying around with me in case of pain. I have only had it in emergency conditions in hospitals when a kidney stone was "on the move". I can't imagine pain much greater than that. It made the pain evaporate within minutes - I thought it was wonderful but I had never heard of the negative side effects - interesting.....

[Guest]

RE: What About The Masseuse?

 

Several countries have banned meperidine or limited its use to anesthesia. I agree that its use should be limited to anesthesia because it is uniquely dangerous: its pain-killing effect lasts only 3 hours, yet its toxic effects accumulate with each (frequent) dose. It's sad that some doctors in the U.S. are still ignorant enough to prescribe it outside the realm of anesthesia:

 

Meperidine [Demerol], a mu opioid analgesic, is commonly used for postoperative pain control. Meperidine is commonly underdosed and administered too infrequently even by physicians aware of its pharmacokinetics (Marks and Sachar, 1973). The common postoperative meperidine order of 75 mg parenterally every 4 hours as needed often is inadequate for several reasons. Meperidine produces clinical analgesia for only 2.5-3.5 hours, and a dose of 75 mg every 4 hours is equivalent to only 5-7.5 mg of morphine. Therefore, to obtain postoperative analgesia equal to that from 10 mg of morphine sulfate every 4 hours, a clinician would have to use 100-150 mg of meperidine every 3 hours. Because of its unique toxicity, meperidine is often contraindicated in patients with impaired renal function and those receiving antidepressants of the monamine oxidase inhibitor class (Wood and Cousins, 1989). Normeperidine (6-N-desmethylmeperidine) is a toxic meperidine metabolite excreted through the kidney. In patients with normal renal function, normeperidine has a half-life of 15 to 20 hours; this time is extended greatly in elderly individuals and patients with impaired renal function. Normeperidine is a cerebral irritant that can cause effects ranging from dysphoria and irritable mood to convulsions (Kaiko, Foley, Grabinski, Heidrich, Rogers, Inturissi, and Reidenberg, 1983; Sieto, Inturrisi, Houde, Saal, Cheigh, and Reidenberg, 1977). These effects have been observed even in young, otherwise healthy patients given sufficiently high doses of normeperidine postoperatively. Therefore, meperidine should be reserved for very brief courses in otherwise healthy patients who have demonstrated an unusual reaction (e.g., local histamine release at the infusion site) or allergic response during treatment with other opioids such as morphine or hydromorphone.

[JT Brooklyn]

R.I.P. Heath......