EMEDZ.NET

Disclaimer Notice:

Dear Readers! I started this blog when my daughter was in the NICU. She had ventriculitis. Her CSF report grew E.coli. But, she was injected Teicoplanin directly into her brain. The doctors made two errors here:

Teicoplanin is for gram-positive bacteria only. It does not treat E.coli.
Teicoplanin is not for intraventricular use. The manufacturer strongly discourage injecting Teicoplanin into the brain.

My daughter bled into the brain. She lived for another two years and ultimately died.

The information provided on Emedz.net is for doctors and pharmacists only to manage their patients in the best way and avoid medications-related errors.

Still, for the general population, this should not be considered professional medical advice or a substitute for consultation with a licensed healthcare provider. The content on this blog is not intended to diagnose, treat, cure, or prevent any disease or health condition.

Always seek the advice of a qualified healthcare professional before making any changes to your diet, exercise routine, medication, or any other aspect of your healthcare. We strongly discourage self-medication and self-treatment.

Even though the primary author of emedz.net is an experienced health professional, the blog is not intended to replace medical advice sought at the Doctor’s Clinic.

The authors share personal experiences, research findings, and general knowledge about health and wellness and medications-related topics.

However, individual health situations vary, and what works for one person may not work for another. It's important to consult with a healthcare provider for personalized guidance.

We strive to provide accurate and up-to-date information, but medical knowledge is constantly evolving. Therefore, we do not guarantee the accuracy, completeness, or timeliness of the information presented in this blog.

Emedz.net is not an online pharmacy:

Online pharmacies sell medicines and pharmaceutical products. EMEDZ.net is intended to provide drug-related information to pharmacists and physicians. It is intended to provide authentic information about medicines so as to prevent errors related to prescriptions.

We do not sell medicines, so please don’t ask for them.

We are not affiliated with any pharmaceutical companies:

Emedz.net has no affiliation with any pharmaceutical companies. We do not promote any product. Sometimes brand names are also mentioned in the title of the page, but that is what is called a “Featured Image”. It has nothing to do with selling or promoting that brand. Just to make things easier, generic and brands are mentioned in the blog.

Emedz.net may contain links to external websites or resources for your convenience. We do not endorse or take responsibility for the content of these external sites.

In no event shall Emedz.net, its authors, contributors, or any related parties be liable for any damages or consequences arising from the use of the information provided on this blog.

By using Emedz.net, you acknowledge and agree to this disclaimer and our Terms of Use. If you do not agree with this disclaimer or our Terms of Use, we advise you to refrain from using our website.

Remember, your health is a valuable asset, and decisions about your health should always be made in consultation with a qualified healthcare professional.

Meperidine and promethazine (Mepergan) - Uses, Dose, Contraindications

Meperidine and promethazine are two distinct medications with different uses and mechanisms of action.

Meperidine: Also known as Demerol, meperidine is a synthetic opioid analgesic. It's primarily used to relieve moderate to severe pain. Meperidine works by binding to opioid receptors in the central nervous system, thereby altering the perception of pain. It is often used in situations where other opioids are not suitable or tolerated due to side effects or contraindications.
Promethazine: Promethazine is an antihistamine medication with multiple uses. It is commonly used to treat allergies, such as hay fever, and symptoms of the common cold, such as sneezing, itching, and runny nose. Promethazine also has antiemetic (anti-nausea) properties, making it useful in managing nausea and vomiting associated with various conditions, including motion sickness and certain types of anesthesia. Additionally, it can be used as a sedative in some cases due to its central nervous system depressant effects.

Meperidine and promethazine (Mepergan) is a combination of opioid medicine and a first-generation antihistamine that is used to treat patients with moderate to severe pain.

Meperidine and promethazine Uses:

Pain:
- Possibly effective as an analgesic for moderate to moderately severe pain.

Meperidine and promethazine (Mepergan) Dose in Adults:

Meperidine and promethazine (Mepergan) Dose in the treatment of Pain:

In treating pain, the typical dosage for meperidine and promethazine taken orally is one capsule containing 50 milligrams of meperidine and 25 milligrams of promethazine.
You take this capsule every 4 to 6 hours as needed for pain relief.
Remember to follow your doctor's instructions carefully regarding when and how often to take these medications.

Use in Children:

Not indicated.

Pregnancy Risk Category: C

It's important to know that using meperidine for a long time during pregnancy can lead to a serious condition in newborns called neonatal opioid withdrawal syndrome, which can be life-threatening if not managed properly.
If a pregnant woman needs to use opioids for an extended period, doctors should explain the risk of this syndrome to her and make sure there's a plan in place for treating it if it happens.
It's essential to refer to specific information about these medications for more details.

Use during breastfeeding:

Meperidine can pass into breast milk, as shown in a study by Spigset in 2000, while the excretion of promethazine into breast milk is not well understood.
Because there's a risk of serious side effects in nursing infants, the manufacturer suggests deciding whether to stop breastfeeding or stop taking the medication, considering how crucial the treatment is for the mother.
It's important to check specific information about these drugs for more guidance.

Dose in Kidney Disease:

The manufacturer's labeling doesn't include specific dosage adjustments for meperidine, but it's important to avoid using meperidine in people with kidney problems, as noted by the Institute for Safe Medication Practices (ISMP) in 2007.
Renal impairment can affect how the body processes and eliminates medications like meperidine, potentially leading to harmful effects.

Dose in Liver disease:

The manufacturer's labeling doesn't outline specific dosage adjustments for meperidine in cases of liver impairment.
However, caution should be exercised when using meperidine in individuals with liver problems.
Liver impairment can affect how medications are metabolized and cleared from the body, potentially altering their effectiveness and increasing the risk of adverse effects.

See individual agents (Meperidine and promethazine).

Contraindications to Meperidine and promethazine:

If someone is allergic to meperidine or promethazine or any part of the medicine, they shouldn't use it.
Also, it's not safe to take these medications if you've used MAO inhibitors in the past 14 days or if you're in a coma.
These medicines aren't suitable for children under 2 years old either.
We're not entirely sure about the chances of having an allergic reaction to one opioid painkiller if you're allergic to another one, but since they're similar in structure and how they work, there might be a possibility of having a reaction.

Warnings and precautions

CNS depression:

Meperidine and promethazine can lead to CNS (central nervous system) depression, which might make it hard for you to stay alert mentally or physically.
It's important to be cautious when doing activities that need you to be fully awake and alert, like operating machinery or driving.
Make sure you understand how these medications affect you before you engage in tasks that require your full attention.

Extrapyramidal symptoms:

Promethazine can sometimes lead to what are called extrapyramidal symptoms, which affect movement and muscle control.
These symptoms may include things like pseudo-parkinsonism, which resembles Parkinson's disease, acute dystonic reactions causing sudden muscle contractions, akathisia which is a feeling of restlessness, and tardive dyskinesia, which involves involuntary movements of the face and body.

Hypotension/orthostatic hypotension:

Meperidine can sometimes lead to low blood pressure, including a type called orthostatic hypotension, where blood pressure drops suddenly when you stand up.
It's important to be cautious if you have conditions like low blood volume, heart problems (including recent heart attacks), or if you're taking medications that can make low blood pressure worse, like phenothiazines or general anesthetics.
Similarly, promethazine can also cause orthostatic hypotension.
If you experience symptoms like dizziness or lightheadedness when you change positions, let your doctor know, as they may need to adjust your treatment plan.

Photosensitivity

Promethazine can make your skin more sensitive to sunlight, which means you might get sunburned more easily.
It's important to avoid spending too much time in the sun and to wear protective clothing and sunscreen when you're outside.
If you notice any skin irritation or sunburn while taking promethazine, let your doctor know.

Respiratory depression [US Boxed Warning]

Serious, life-threatening, or even fatal respiratory depression can happen with medications like meperidine.
It's crucial to watch closely for signs of respiratory depression, especially when starting the medication or increasing the dose.
Opioid-induced respiratory depression can lead to a buildup of carbon dioxide in the body, which can worsen the sedative effects of opioids.
If you or someone you know experiences difficulty breathing or extreme drowsiness while taking meperidine, seek medical help immediately.

Conditions abdominales:

Meperidine can make it harder for doctors to diagnose or understand the progress of patients with acute abdominal conditions.
This means that the pain-relieving effects of meperidine might mask the symptoms of these conditions, making it difficult to figure out what's really going on inside the abdomen.
If you have severe abdominal pain or suspect you have an abdominal issue, it's important to let your doctor know if you're taking meperidine so they can take appropriate steps to diagnose and treat the problem effectively.

Use of drugs:

When using opioids like meperidine for long-term pain management, it's important to be cautious, especially in patients who might be more likely to misuse them.
Factors that increase the risk of misuse include a history of substance use disorder, being younger, having depression, and taking other medications that affect the mind.
For patients with factors linked to a higher risk of overdose, such as a history of overdose or substance use disorder, higher opioid doses, or using benzodiazepines alongside opioids, it may be helpful to consider offering them naloxone prescriptions.
Naloxone is a medication that can reverse opioid overdose and could potentially save lives in emergency situations.

Acute alcoholism

It's important to be cautious when using meperidine in patients with acute alcoholism.
Meperidine, like other opioids, can have effects on the central nervous system, and combining it with alcohol can increase the risk of respiratory depression, sedation, and other adverse effects.

Insufficiency of the adrenals:

It's important to exercise caution when using meperidine in patients with adrenal insufficiency, which includes conditions like Addison's disease.
Adrenal insufficiency affects the body's ability to produce certain hormones, including cortisol, which helps regulate stress response and metabolism.
Meperidine, like other opioids, can affect hormone levels and may exacerbate symptoms in patients with adrenal insufficiency.

Delirium tremens:

It's important to be cautious when using meperidine in patients with delirium tremens.
Delirium tremens is a severe form of alcohol withdrawal characterized by confusion, hallucinations, and severe agitation.
Meperidine, like other opioids, can affect the central nervous system and may exacerbate symptoms of delirium tremens or interact with medications used to manage the condition.

Head trauma

It's crucial to exercise extreme caution when using meperidine in patients with head injuries, intracranial lesions, or elevated intracranial pressure (ICP).
Meperidine, like other opioids, can potentially increase intracranial pressure, which may worsen the condition in individuals with head trauma or other intracranial issues.

Hepatic impairment

It's important to be cautious when using meperidine in patients with hepatic (liver) disorders.
Liver impairment can affect how the body metabolizes and eliminates medications, potentially leading to increased levels of meperidine in the bloodstream and a higher risk of adverse effects.

Mental health conditions

It's important to approach the use of opioids with caution in patients who have mental health conditions such as depression, anxiety disorders, or post-traumatic stress disorder (PTSD) and are experiencing chronic pain.
These individuals may have an increased risk of developing opioid use disorder or experiencing overdose.

Pheochromocytoma:

It's important to use meperidine with caution in patients with pheochromocytoma.
Pheochromocytoma is a rare tumor of the adrenal gland that can cause the release of large amounts of adrenaline and noradrenaline, leading to high blood pressure and other cardiovascular complications.
Meperidine, like other opioids, can potentially increase blood pressure and heart rate, which may worsen the symptoms of pheochromocytoma.

Prostatic hyperplasia/urinary restriction:

It's important to use meperidine with caution in patients with conditions like prostatic hyperplasia (enlargement of the prostate gland) or urinary stricture (narrowing of the urethra).
Meperidine, like other opioids, can cause urinary retention or make it more difficult to urinate, which can worsen symptoms in individuals with these conditions.

Renal impairment

t's crucial to exercise caution when using meperidine in patients with renal impairment (kidney problems).
Meperidine and its metabolites can accumulate in the body in individuals with reduced kidney function, leading to potential toxicity and adverse effects.

Respiratory disease

If you have breathing problems already, like COPD or other lung diseases, or if you have issues with your spine that affect how you breathe, you should be careful with meperidine.
Even at normal doses, it can make your breathing slow down too much, which can be dangerous.
So, if you have any of these conditions, it's important to use meperidine cautiously and watch out for any changes in your breathing.

Seizure disorder:

If you're at risk of having seizures, like if you've had them before, have had head injuries, brain damage, or if you drink a lot of alcohol, you should be careful with promethazine.
This medication can sometimes lower the threshold for having seizures, meaning it might make it more likely for you to have one.
Meperidine, especially in high doses, can also increase the risk of seizures.

Sleep-disordered breathing

If you have risk factors for sleep-disordered breathing, like heart failure (HF) or obesity, it's important to be cautious when using opioids for chronic pain.
Opioids can affect your breathing, especially during sleep, which can be concerning if you already have breathing problems.
Your doctor may need to adjust the dosage of opioids carefully and might recommend avoiding them altogether if your sleep-disordered breathing is moderate to severe.

Sickle-cell Disease:

It's important to be cautious when using meperidine in patients with sickle cell disease.
Meperidine can sometimes cause a side effect called serotonin syndrome, which is more likely to happen when combined with other medications that also affect serotonin levels in the brain.
Therefore, it's important to monitor for symptoms of serotonin syndrome, which can include confusion, hallucinations, rapid heartbeat, and high body temperature, especially when starting or changing doses of meperidine or when combining it with other medications.
If you experience any of these symptoms, it's essential to seek medical attention right away.

Tachycardia

If you have a condition called supraventricular tachycardia, which is a type of fast heartbeat that starts in the upper chambers of the heart, you should be careful when using meperidine.
Meperidine might increase how fast your heart beats, especially in the lower chambers, possibly because it affects a nerve that slows down the heart.
So, if you have this condition, it's important to use meperidine cautiously and watch out for any changes in your heartbeat.

Thyroid dysfunction:

If you have thyroid problems like myxedema or hypothyroidism, you should be careful when using meperidine.
Meperidine can affect how your body responds to certain hormones, including those produced by the thyroid gland.
So, if you have thyroid issues, it's important to use meperidine cautiously and monitor how you feel while taking it.
If you notice any unusual symptoms or changes in your health, be sure to talk to your doctor about them.

Meperidine and promethazine: Drug Interaction

Risk Factor C (Monitor therapy)
Acetylcholinesterase Inhibitors	May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors.
Alizapride	May enhance the CNS depressant effect of CNS Depressants.
Almotriptan	May enhance the serotonergic effect of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined.
Alosetron	May enhance the serotonergic effect of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined.
Amantadine	May enhance the anticholinergic effect of Anticholinergic Agents.
Amifampridine	Agents With Seizure Threshold Lowering Potential may enhance the neuroexcitatory and/or seizure-potentiating effect of Amifampridine.
Aminolevulinic Acid (Topical)	Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical).
Amphetamines	May enhance the analgesic effect of Opioid Agonists.
Amphetamines	May enhance the serotonergic effect of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined.
Anticholinergic Agents	May enhance the adverse/toxic effect of other Anticholinergic Agents.
Anticholinergic Agents	May enhance the adverse/toxic effect of Opioid Agonists. Specifically, the risk for constipation and urinary retention may be increased with this combination.
Antiemetics (5HT3 Antagonists)	May enhance the serotonergic effect of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Exceptions: Alosetron; Ondansetron; Ramosetron.
Botulinum Toxin-Containing Products	May enhance the anticholinergic effect of Anticholinergic Agents.
Brimonidine (Topical)	May enhance the CNS depressant effect of CNS Depressants.
BuPROPion	May enhance the neuroexcitatory and/or seizure-potentiating effect of Agents With Seizure Threshold Lowering Potential.
BusPIRone	May enhance the serotonergic effect of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined.
Cannabidiol	May enhance the CNS depressant effect of CNS Depressants.
Cannabis	May enhance the CNS depressant effect of CNS Depressants.
Chlorphenesin Carbamate	May enhance the adverse/toxic effect of CNS Depressants.
Cimetidine	May increase the serum concentration of Meperidine.
CYP3A4 Inducers (Moderate)	May decrease the serum concentration of Meperidine.
CYP3A4 Inducers (Strong)	May decrease the serum concentration of Meperidine.
CYP3A4 Inhibitors (Moderate)	May increase the serum concentration of Meperidine.
CYP3A4 Inhibitors (Strong)	May increase the serum concentration of Meperidine. Exceptions: Nefazodone.
Desmopressin	Opioid Agonists may enhance the adverse/toxic effect of Desmopressin.
Dexmethylphenidate-Methylphenidate	May enhance the serotonergic effect of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined.
Dextromethorphan	May enhance the serotonergic effect of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined.
Dimethindene (Topical)	May enhance the CNS depressant effect of CNS Depressants.
Diuretics	Opioid Agonists may enhance the adverse/toxic effect of Diuretics. Opioid Agonists may diminish the therapeutic effect of Diuretics.
Dronabinol	May enhance the CNS depressant effect of CNS Depressants.
Eletriptan	May enhance the serotonergic effect of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined.
EPINEPHrine (Nasal)	Promethazine may diminish the vasoconstricting effect of EPINEPHrine (Nasal).
EPINEPHrine (Oral Inhalation)	Promethazine may diminish the therapeutic effect of EPINEPHrine (Oral Inhalation).
Epinephrine (Racemic)	Promethazine may diminish the vasoconstricting effect of Epinephrine (Racemic). Management: Monitor for diminished vasoconstrictive effects of racemic epinephrine (e.g., diminished efficacy when used for gingival retraction). This interaction is likely of less concern in patients receiving epinephrine for other purposes (e.g., bronchodilation).
Ergot Derivatives	May enhance the serotonergic effect of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Exceptions: Nicergoline.
Fosphenytoin	May decrease the serum concentration of Meperidine.
Gastrointestinal Agents (Prokinetic)	Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic).
Gastrointestinal Agents (Prokinetic)	Opioid Agonists may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic).
Glucagon	Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased.
Itopride	Anticholinergic Agents may diminish the therapeutic effect of Itopride.
Kava Kava	May enhance the adverse/toxic effect of CNS Depressants.
Lofexidine	May enhance the CNS depressant effect of CNS Depressants. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Lorcaserin	May enhance the serotonergic effect of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined.
Magnesium Sulfate	May enhance the CNS depressant effect of CNS Depressants.
MetyroSINE	May enhance the adverse/toxic effect of Promethazine.
Minocycline (Systemic)	May enhance the CNS depressant effect of CNS Depressants.
Mirabegron	Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron.
Nabilone	May enhance the CNS depressant effect of CNS Depressants.
Nitroglycerin	Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption.
Ondansetron	May enhance the serotonergic effect of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined.
Oxitriptan	Serotonergic Agents (High Risk) may enhance the serotonergic effect of Oxitriptan. This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined.
Pegvisomant	Opioid Agonists may diminish the therapeutic effect of Pegvisomant.
Phenytoin	May decrease the serum concentration of Meperidine.
Piribedil	CNS Depressants may enhance the CNS depressant effect of Piribedil.
Porfimer	Photosensitizing Agents may enhance the photosensitizing effect of Porfimer.
Pramipexole	CNS Depressants may enhance the sedative effect of Pramipexole.
Ramosetron	Anticholinergic Agents may enhance the constipating effect of Ramosetron.
Ramosetron	Opioid Agonists may enhance the constipating effect of Ramosetron.
Ramosetron	May enhance the serotonergic effect of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined.
ROPINIRole	CNS Depressants may enhance the sedative effect of ROPINIRole.
Rotigotine	CNS Depressants may enhance the sedative effect of Rotigotine.
Rufinamide	May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced.
Selective Serotonin Reuptake Inhibitors	CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced.
Selective Serotonin Reuptake Inhibitors	Serotonergic Opioids (High Risk) may enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) if these agents are combined. Exceptions: Dapoxetine.
Serotonergic Agents (High Risk, Miscellaneous)	Serotonergic Opioids (High Risk) may enhance the serotonergic effect of Serotonergic Agents (High Risk, Miscellaneous). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) if these agents are combined.
Serotonin 5-HT1D Receptor Agonists (Triptans)	May enhance the serotonergic effect of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Exceptions: Almotriptan; Eletriptan.
Serotonin/Norepinephrine Reuptake Inhibitors	Meperidine may enhance the serotonergic effect of Serotonin/Norepinephrine Reuptake Inhibitors. This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) if these agents are combined.
St John's Wort	May enhance the serotonergic effect of Serotonergic Agents (High Risk). This could result in serotonin syndrome. St John's Wort may decrease the serum concentration of Serotonergic Agents (High Risk). Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined.
Succinylcholine	May enhance the bradycardic effect of Opioid Agonists.
Syrian Rue	May enhance the serotonergic effect of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined.
Tetrahydrocannabinol	May enhance the CNS depressant effect of CNS Depressants.
Tetrahydrocannabinol and Cannabidiol	May enhance the CNS depressant effect of CNS Depressants.
Thiazide and Thiazide-Like Diuretics	Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics.
Verteporfin	Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin.
Risk Factor D (Consider therapy modification)
Alvimopan	Opioid Agonists may enhance the adverse/toxic effect of Alvimopan. This is most notable for patients receiving long-term (i.e., more than 7 days) opiates prior to alvimopan initiation. Management: Alvimopan is contraindicated in patients receiving therapeutic doses of opioids for more than 7 consecutive days immediately prior to alvimopan initiation.
Blonanserin	CNS Depressants may enhance the CNS depressant effect of Blonanserin.
Chlormethiazole	May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used.
CNS Depressants	May enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Droperidol	May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
EPINEPHrine (Systemic)	Promethazine may diminish the vasoconstricting effect of EPINEPHrine (Systemic). Management: When vasoconstrictive effects are desired in patients receiving promethazine, consider alternatives to epinephrine. Consider use of norepinephrine or phenylephrine, and avoid epinephrine, when treating hypotension associated with promethazine overdose.
FentaNYL	Meperidine may enhance the CNS depressant effect of FentaNYL. Meperidine may enhance the serotonergic effect of FentaNYL. This could result in serotonin syndrome. Management: Consider alternatives to this combination. If use is necessary, monitor for signs and symptoms of serotonin syndrome/serotonin toxicity and CNS depression.
Flunitrazepam	CNS Depressants may enhance the CNS depressant effect of Flunitrazepam.
HYDROcodone	CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
HydrOXYzine	May enhance the CNS depressant effect of Meperidine. Management: Consider a decrease in meperidine dose, as appropriate, when used together with hydroxyzine. With concurrent use, monitor patients closely for excessive response to the combination.
Iohexol	Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iohexol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iohexol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.
Iomeprol	Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iomeprol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iomeprol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.
Iopamidol	Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iopamidol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iopamidol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.
Lemborexant	May enhance the CNS depressant effect of CNS Depressants. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary.
Linezolid	May enhance the serotonergic effect of Serotonergic Opioids (High Risk). This could result in serotonin syndrome. Management: Consider alternatives to this drug combination. If combined, monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes).
Methotrimeprazine	CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established.
Methylene Blue	May enhance the serotonergic effect of Serotonergic Opioids (High Risk). This could result in serotonin syndrome. Management: Consider alternatives to this drug combination. If combined, monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes).
Nalmefene	May diminish the therapeutic effect of Opioid Agonists. Management: Avoid the concomitant use of nalmefene and opioid agonists. Discontinue nalmefene 1 week prior to any anticipated use of opioid agonistss. If combined, larger doses of opioid agonists will likely be required.
Naltrexone	May diminish the therapeutic effect of Opioid Agonists. Management: Seek therapeutic alternatives to opioids. See full drug interaction monograph for detailed recommendations.
Nefazodone	May enhance the serotonergic effect of Meperidine. This could result in serotonin syndrome. Nefazodone may increase the serum concentration of Meperidine. Management: Consider reducing meperidine dose. Monitor for signs and symptoms of respiratory depression, sedation, and serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia) when these agents are combined.
Opioid Agonists	CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
OxyCODONE	CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Perampanel	May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination.
Pramlintide	May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract.
Secretin	Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin.
Serotonergic Non-Opioid CNS Depressants	May enhance the CNS depressant effect of Serotonergic Opioids (High Risk). Serotonergic Non-Opioid CNS Depressants may enhance the serotonergic effect of Serotonergic Opioids (High Risk). This could result in serotonin syndrome. Management: Consider alternatives to this drug combination. If combined, monitor for signs and symptoms of serotonin syndrome/serotonin toxicity and CNS depression.
Sincalide	Drugs that Affect Gallbladder Function may diminish the therapeutic effect of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction.
Sodium Oxybate	May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated.
Suvorexant	CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended.
Tapentadol	May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
TraMADol	Serotonergic Opioids (High Risk) may enhance the CNS depressant effect of TraMADol. Serotonergic Opioids (High Risk) may enhance the serotonergic effect of TraMADol. This could result in serotonin syndrome. Management: Consider alternatives to this drug combination. If combined, monitor for signs and symptoms of serotonin syndrome/serotonin toxicity and CNS depression.
Tricyclic Antidepressants	May enhance the CNS depressant effect of Serotonergic Opioids (High Risk). Serotonergic Opioids (High Risk) may enhance the serotonergic effect of Tricyclic Antidepressants. This could result in serotonin syndrome. Management: Consider alternatives to this drug combination. If combined, monitor for signs and symptoms of serotonin syndrome/serotonin toxicity and CNS depression.
Zolpidem	CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol.
Risk Factor X (Avoid combination)
Aclidinium	May enhance the anticholinergic effect of Anticholinergic Agents.
Aminolevulinic Acid (Systemic)	Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic).
Azelastine (Nasal)	CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal).
Bromopride	May enhance the adverse/toxic effect of Promethazine.
Bromperidol	May enhance the CNS depressant effect of CNS Depressants.
Cimetropium	Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium.
Dapoxetine	May enhance the serotonergic effect of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Do not use serotonergic agents (high risk) with dapoxetine or within 7 days of serotonergic agent discontinuation. Do not use dapoxetine within 14 days of monoamine oxidase inhibitor use. Dapoxetine labeling lists this combination as contraindicated.
Eluxadoline	Opioid Agonists may enhance the constipating effect of Eluxadoline.
Eluxadoline	Anticholinergic Agents may enhance the constipating effect of Eluxadoline.
Glycopyrrolate (Oral Inhalation)	Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation).
Glycopyrronium (Topical)	May enhance the anticholinergic effect of Anticholinergic Agents.
Ipratropium (Oral Inhalation)	May enhance the anticholinergic effect of Anticholinergic Agents.
Levosulpiride	Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride.
Metoclopramide	May enhance the adverse/toxic effect of Promethazine.
Monoamine Oxidase Inhibitors (Antidepressant)	Meperidine may enhance the serotonergic effect of Monoamine Oxidase Inhibitors (Antidepressant). This could result in serotonin syndrome.
Monoamine Oxidase Inhibitors (Type B)	Serotonergic Opioids (High Risk) may enhance the serotonergic effect of Monoamine Oxidase Inhibitors (Type B). This could result in serotonin syndrome.
Opioids (Mixed Agonist / Antagonist)	May diminish the analgesic effect of Opioid Agonists. Management: Seek alternatives to mixed agonist/antagonist opioids in patients receiving pure opioid agonists, and monitor for symptoms of therapeutic failure/high dose requirements (or withdrawal in opioid-dependent patients) if patients receive these combinations.
Orphenadrine	CNS Depressants may enhance the CNS depressant effect of Orphenadrine.
Oxatomide	May enhance the anticholinergic effect of Anticholinergic Agents.
Oxomemazine	May enhance the CNS depressant effect of CNS Depressants.
Paraldehyde	CNS Depressants may enhance the CNS depressant effect of Paraldehyde.
Potassium Chloride	Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride.
Potassium Citrate	Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate.
Revefenacin	Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin.
Thalidomide	CNS Depressants may enhance the CNS depressant effect of Thalidomide.
Tiotropium	Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium.
Umeclidinium	May enhance the anticholinergic effect of Anticholinergic Agents.

Monitoring parameters:

Observations During Treatment:

Pain Relief: Monitor how well the medication is working to relieve pain.
Respiratory Status: Watch for signs of breathing problems, like slow or shallow breathing.
Mental Status: Keep an eye out for excessive drowsiness or confusion.

Alternate Recommendations for Chronic Pain:

Evaluation: Assess the benefits and risks of opioid therapy within the first 1 to 4 weeks of starting treatment and whenever the dosage is increased.
Re-evaluation: Review the benefits and risks every 3 months while on opioid therapy, or more often if there's a higher risk of overdose or opioid use disorder.
Urine Testing: Consider urine drug testing before starting opioid therapy and possibly once a year thereafter to monitor for controlled prescription medications or illicit drug use.
Prescription Monitoring: Check the state prescription drug monitoring program data before starting opioid therapy and periodically during treatment, ranging from every prescription to every 3 months.

These steps are recommended to ensure safe and effective pain management while minimizing the risks associated with long-term opioid use.

How to administer Meperidine and promethazine?

It is taken with meals. The suspension/ syrup is mixed with a glass of water or a half glass of water and ingested. Ingesting undiluted syrup may numb the lips, tongue, and oral cavity.

Mechanism of action of Meperidine and promethazine:

Meperidine is a type of pain-relieving medication known as an opioid analgesic, while promethazine is a medication derived from phenothiazine with sedative and anti-nausea properties.
Each medication has its own specific uses and effects, so it's important to refer to the detailed information provided for each one to understand how they work and when they should be used.

Meperidine and promethazine International Brand Names: