Acute pethidine overdose produces the classical opioid triad of respiratory depression, decreased consciousness, and — in a notable departure from other opioids — mydriasis (not miosis) and tachycardia (not bradycardia) due to concurrent anticholinergic activitysupported
Notably does NOT cause miosis (unlike other opioids). Common adverse effects: nausea, vomiting, respiratory depression, constipation, addiction. aapm.119156
Claim in safety — inconclusiveinconclusiveworking →
Claim in safety — inconclusiveinconclusiveworking →
Claim in safety — inconclusiveinconclusiveworking →
Claim in safety — inconclusiveinconclusiveworking →
MAOI + pethidine: can produce hyperthermia, agitation, clonus, and death. The reaction may be excitatory (serotonin syndrome) or depressant (coma, respiratory failure, hypotension)supported
Serotonergic drugs including meperidine can cause serotonin syndrome when combined with MAOIs. 5-HT reuptake inhibitors are contraindicated. 001c.39576
MAOI + pethidine: can produce hyperthermia, agitation, clonus, and death. The reaction may be excitatory (serotonin syndrome) or depressant (coma, respiratory failure, hypotension)supported
Serotonin syndrome may result from coadministration of pethidine with MAOIs or SSRIs. pmid:9747665
SSRI + pethidine: serotonin syndrome risk documented; combination requires extreme cautionsupported
Tramadol and meperidine (not morphine) induce serotonin syndrome-like behaviors in SERT-deficient mice. s146114570900011x
Claim in safety — inconclusiveinconclusiveworking →
SERT-deficient mice demonstrate exaggerated serotonergic responses to meperidine, confirming the transporter-mediated mechanismsupported
Tramadol and meperidine (not morphine) induce serotonin syndrome-like behaviors in SERT-deficient mice. Exaggerated in SERT-/- mice. Response blocked by 5-HT1A antagonist WAY 100635. s146114570900011x
High-dose or prolonged use produces cognitive dysfunction and delirium — particularly in elderly patients, where pethidine is associated with higher delirium rates than alternative opioids.supported
Meperidine listed as PIM to always avoid in older adults due to neurotoxicity (normeperidine accumulation), delirium risk, ineffectiveness at oral doses, and availability of safer alternatives. jgs.18372
High-dose or prolonged use produces cognitive dysfunction and delirium — particularly in elderly patients, where pethidine is associated with higher delirium rates than alternative opioids.supported
Cognitive dysfunction from opioids in cancer; elevation of opioid metabolites (including normeperidine) in renal impairment contributes to cognitive dysfunction. cncr.10389
Claim in safety — inconclusiveinconclusiveworking →
Claim in safety — inconclusiveinconclusiveworking →
Claim in safety — inconclusiveinconclusiveworking →
Claim in safety — inconclusiveinconclusiveworking →
Claim in safety — inconclusiveinconclusiveworking →
SSRIs combined with pethidine also produce serotonin syndrome, confirmed in both animal models and clinical reportssupported
Tramadol and meperidine (not morphine) induce serotonin syndrome-like behaviors in SERT-deficient mice. Exaggerated in SERT-/- mice. s146114570900011x
Claim in safety — inconclusiveinconclusiveworking →
MAOI use within 14 days — serotonin syndrome or severe CNS/respiratory depression; this is the single most dangerous contraindication in opioid pharmacologysupported
Serotonergic drugs including meperidine can cause serotonin syndrome when combined with MAOIs. 5-HT reuptake inhibitors are contraindicated. 001c.39576
MAOI use within 14 days — serotonin syndrome or severe CNS/respiratory depression; this is the single most dangerous contraindication in opioid pharmacologysupported
Serotonin syndrome may result from coadministration of pethidine with MAOIs or SSRIs. pmid:9747665
Claim in safety — inconclusiveinconclusiveworking →
Older adults — 2023 AGS Beers Criteria: always avoid; delirium risk, normeperidine toxicity, inefficacy at common oral dosessupported
Meperidine listed as PIM to always avoid in older adults due to neurotoxicity (normeperidine accumulation), delirium risk, ineffectiveness at oral doses, and availability of safer alternatives. jgs.18372
Claim in safety — inconclusiveinconclusiveworking →
Claim in safety — inconclusiveinconclusiveworking →
Claim in safety — inconclusiveinconclusiveworking →
Concurrent SSRI use — serotonin syndrome risksupported
Tramadol and meperidine (not morphine) induce serotonin syndrome-like behaviors in SERT-deficient mice. s146114570900011x
Claim in safety — inconclusiveinconclusiveworking →