Meperidine and promethazine (Injection route)

Pronunciation:

me-PER-i-deen hye-droe-KLOR-ide, proe-METH-a-zeen hye-droe-KLOR-ide

Brand Names:

Mepergan

Warnings:

Injection route(Solution)

Because the use of meperidine hydrochloride/promethazine hydrochloride injection exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death, assess each patient's risk prior to prescribing, and reassess all patients regularly for the development of these behaviors and conditions. Serious, life-threatening, or fatal respiratory depression may occur with use of meperidine hydrochloride/promethazine hydrochloride injection, especially during the initiation or following a dosage increase. To reduce the risk of respiratory depression, proper dosing and titration of meperidine hydrochloride/promethazine hydrochloride injection are essential. Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of meperidine hydrochloride/promethazine hydrochloride injection and benzodiazepines or other CNS depressants for use in patients for whom alternative treatment options are inadequate. If opioid use is required for an extended period of time in a pregnant woman, advise the patient of the risks of NOWS, which may be life-threatening if not recognized and treated. Ensure that management by neonatology experts will be available at delivery. The concomitant use of meperidine hydrochloride/promethazine hydrochloride injection with all cytochrome P450 3A4 inhibitors may result in an increase in meperidine plasma concentrations, which could increase or prolong adverse reactions and may cause potentially fatal respiratory depression. In addition, discontinuation of a concomitantly used cytochrome P450 3A4 inducer may result in an increase in meperidine plasma concentration. Regularly evaluate patients receiving meperidine hydrochloride/promethazine hydrochloride injection and any CYP3A4 inhibitor or inducer. Concomitant use of meperidine hydrochloride/promethazine hydrochloride injection with monoamine oxidase (MAO) inhibitors can result in coma, severe respiratory depression, cyanosis, and hypotension. Use of meperidine hydrochloride/promethazine hydrochloride injection with MAO inhibitors within last 14 days is contraindicated .

Classifications:

Pharmacologic—

Promethazine

Chemical—

Meperidine

Uses of This Medicine:

Meperidine and promethazine combination injection is used to treat pain severe enough to require opioid treatment and when other pain medicines did not work well enough or cannot be tolerated. It is also used with other medicines just before or during an operation to help the anesthetic (numbing medicine) work better.

Meperidine belongs to the group of medicines called narcotic analgesics (pain medicines). It acts in the central nervous system (CNS) or brain to relieve pain.

Promethazine is an antihistamine. It works by preventing the effects of a substance called histamine, which is produced by the body. Histamine can cause itching, sneezing, runny nose, and watery eyes. It can sometimes close up the bronchial tubes (air passages of the lungs) and make breathing difficult.

When meperidine is used for a long time, it may become habit-forming, causing mental or physical dependence. However, people who have continuing pain should not let the fear of dependence keep them from using narcotics to relieve their pain. Mental dependence (addiction) is not likely to occur when narcotics are used for this purpose. Physical dependence may lead to withdrawal side effects if treatment is stopped suddenly. However, severe withdrawal side effects can usually be prevented by gradually reducing the dose over a period of time before treatment is stopped completely.

This medicine is to be given only by or under the immediate supervision of your doctor.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies have not been performed on the relationship of age to the effects of Mepergan® injection in the pediatric population. Safety and efficacy have not been established.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of Mepergan® injection in the elderly. However, elderly patients are more likely to have age-related lung, kidney, liver, or heart problems, which may require caution and an adjustment in the dose for patients receiving Mepergan® injection.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Bepridil
Bromopride
Calcium Oxybate
Cisapride
Dronedarone
Furazolidone
Iproniazid
Isocarboxazid
Levoketoconazole
Linezolid
Magnesium Oxybate
Mesoridazine
Methylene Blue
Moclobemide
Nalmefene
Naltrexone
Nialamide
Phenelzine
Pimozide
Piperaquine
Potassium Citrate
Potassium Oxybate
Procarbazine
Rasagiline
Safinamide
Samidorphan
Saquinavir
Selegiline
Sodium Oxybate
Sparfloxacin
Terfenadine
Thioridazine
Toloxatone
Tranylcypromine
Ziprasidone

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acepromazine
Adagrasib
Alfentanil
Alfuzosin
Almotriptan
Alprazolam
Amantadine
Amifampridine
Amineptine
Amiodarone
Amisulpride
Amitriptyline
Amitriptylinoxide
Amobarbital
Amoxapine
Amphetamine
Amprenavir
Anagrelide
Anileridine
Apomorphine
Aprepitant
Aripiprazole
Aripiprazole Lauroxil
Armodafinil
Arsenic Trioxide
Asenapine
Astemizole
Atazanavir
Azithromycin
Baclofen
Benperidol
Benzhydrocodone
Benzphetamine
Boceprevir
Bosentan
Bromazepam
Bromopride
Brompheniramine
Buprenorphine
Bupropion
Buserelin
Buspirone
Butabarbital
Butorphanol
Calcium Oxybate
Cannabidiol
Cannabis
Carbamazepine
Carbinoxamine
Carisoprodol
Carphenazine
Ceritinib
Cetirizine
Chloral Hydrate
Chlordiazepoxide
Chloroquine
Chlorpheniramine
Chlorpromazine
Chlorzoxazone
Cimetidine
Ciprofloxacin
Citalopram
Clarithromycin
Clobazam
Clofazimine
Clomipramine
Clonazepam
Clopidogrel
Clorazepate
Clothiapine
Clozapine
Cobicistat
Cocaine
Codeine
Conivaptan
Crizotinib
Cyclobenzaprine
Cyclosporine
Dabrafenib
Daridorexant
Darunavir
Dasatinib
Degarelix
Delamanid
Delavirdine
Desipramine
Deslorelin
Desmopressin
Desvenlafaxine
Deutetrabenazine
Dexamethasone
Dexmedetomidine
Dextroamphetamine
Dextromethorphan
Dezocine
Diazepam
Dibenzepin
Dichloralphenazone
Difenoxin
Dihydrocodeine
Diltiazem
Diphenhydramine
Diphenoxylate
Disopyramide
Dixyrazine
Dofetilide
Dolasetron
Domperidone
Donepezil
Doxepin
Doxylamine
Dronedarone
Droperidol
Duloxetine
Efavirenz
Eletriptan
Encorafenib
Enflurane
Entrectinib
Enzalutamide
Epinephrine
Erythromycin
Escitalopram
Esketamine
Eslicarbazepine Acetate
Estazolam
Eszopiclone
Ethchlorvynol
Ethopropazine
Ethylmorphine
Etrasimod
Etravirine
Fenfluramine
Fentanyl
Fexinidazole
Fingolimod
Flecainide
Flibanserin
Fluconazole
Fluoxetine
Fluphenazine
Flurazepam
Fluspirilene
Fluvoxamine
Formoterol
Fosamprenavir
Fosaprepitant
Foscarnet
Fosphenytoin
Fospropofol
Fostemsavir
Frovatriptan
Gabapentin
Gabapentin Enacarbil
Gatifloxacin
Gemifloxacin
Gepirone
Glasdegib
Glucagon
Glycopyrrolate
Glycopyrronium Tosylate
Gonadorelin
Goserelin
Granisetron
Halazepam
Halofantrine
Haloperidol
Halothane
Hexobarbital
Histrelin
Hydrocodone
Hydromorphone
Hydroxyamphetamine
Hydroxychloroquine
Hydroxytryptophan
Hydroxyzine
Ibutilide
Idelalisib
Iloperidone
Imatinib
Imipramine
Indinavir
Inotuzumab Ozogamicin
Isoflurane
Isradipine
Itraconazole
Ivabradine
Ivacaftor
Ivosidenib
Ketamine
Ketazolam
Ketobemidone
Ketoconazole
Lacosamide
Lapatinib
Lasmiditan
Lefamulin
Lemborexant
Lenvatinib
LetibotulinumtoxinA-wlbg
Leuprolide
Levocetirizine
Levofloxacin
Levomilnacipran
Levorphanol
Lisdexamfetamine
Lithium
Lofepramine
Lofexidine
Lomitapide
Lopinavir
Lorazepam
Lorcaserin
Loxapine
Lumacaftor
Lumefantrine
Macimorelin
Magnesium Oxybate
Meclizine
Mefloquine
Melitracen
Melperone
Meperidine
Mephobarbital
Meprobamate
Meptazinol
Mesoridazine
Metaxalone
Methacholine
Methadone
Methamphetamine
Methocarbamol
Methohexital
Methotrimeprazine
Metoclopramide
Metopimazine
Metrizamide
Metronidazole
Mibefradil
Midazolam
Mifepristone
Milnacipran
Mirtazapine
Mitotane
Mobocertinib
Modafinil
Molindone
Moricizine
Morphine
Morphine Sulfate Liposome
Moxifloxacin
Nafarelin
Nafcillin
Nalbuphine
Naratriptan
Nefazodone
Nelfinavir
Nevirapine
Nicomorphine
Nilotinib
Nirmatrelvir
Nitrazepam
Nitrous Oxide
Norfloxacin
Nortriptyline
Octreotide
Ofloxacin
Olanzapine
Oliceridine
Ondansetron
Opipramol
Opium
Opium Alkaloids
Orphenadrine
Osilodrostat
Osimertinib
Oxaliplatin
Oxazepam
Oxcarbazepine
Oxycodone
Oxymorphone
Ozanimod
Pacritinib
Palbociclib
Paliperidone
Palonosetron
Panobinostat
Papaveretum
Paregoric
Paroxetine
Pasireotide
Pazopanib
Pentamidine
Pentazocine
Pentobarbital
Perampanel
Perazine
Periciazine
Perphenazine
Phenobarbital
Phenytoin
Pimavanserin
Pimozide
Piperacetazine
Pipotiazine
Piritramide
Pitolisant
Ponesimod
Porfimer
Posaconazole
Potassium Oxybate
Prazepam
Prednisone
Pregabalin
Primidone
Procainamide
Procarbazine
Prochlorperazine
Promazine
Promethazine
Propafenone
Propiomazine
Propofol
Protriptyline
Quazepam
Quetiapine
Quinine
Quizartinib
Ramelteon
Ranitidine
Ranolazine
Relugolix
Remifentanil
Remimazolam
Remoxipride
Revefenacin
Ribociclib
Rifabutin
Rifampin
Rifapentine
Rizatriptan
Ropeginterferon Alfa-2b-njft
Saquinavir
Scopolamine
Secobarbital
Secretin Human
Selpercatinib
Sertindole
Sertraline
Sevoflurane
Sibutramine
Siponimod
Sodium Oxybate
Sodium Phosphate
Sodium Phosphate, Dibasic
Sodium Phosphate, Monobasic
Solifenacin
Sorafenib
Sotalol
St John's Wort
Sufentanil
Sulpiride
Sumatriptan
Sunitinib
Suvorexant
Tacrolimus
Tapentadol
Telaprevir
Telavancin
Telithromycin
Temazepam
Tetrabenazine
Thiethylperazine
Thiopental
Thiopropazate
Thioproperazine
Thioridazine
Tianeptine
Tilidine
Tiotropium
Tizanidine
Tolonium Chloride
Topiramate
Toremifene
Tramadol
Trazodone
Triazolam
Triclabendazole
Trifluoperazine
Trifluperidol
Triflupromazine
Trimeprazine
Trimipramine
Triptorelin
Tryptophan
Vandetanib
Vardenafil
Vemurafenib
Venlafaxine
Verapamil
Vilanterol
Vilazodone
Vinflunine
Voclosporin
Voriconazole
Vortioxetine
Zaleplon
Ziprasidone
Zolmitriptan
Zolpidem
Zopiclone
Zotepine
Zuclopenthixol
Zuranolone

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Aminolevulinic Acid
Belladonna
Belladonna Alkaloids
Betel Nut
Evening Primrose
Isoniazid
Midodrine
Phenylalanine
Ritonavir

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

Grapefruit Juice

Using this medicine with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

Ethanol

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

Adrenal problems or
Alcohol abuse, history of or
Brain tumor, history of or
Breathing or other lung problems (eg, COPD, respiratory depression, sleep apnea) or
Cor pulmonale (serious heart condition) or
Drug dependence, especially with narcotics, or history of or
Head injuries, history of—Use with caution. May increase risk for more serious side effects.

Asthma, acute or severe or
Lung or breathing problem (eg, respiratory depression) or
Stomach or bowel blockage (eg, paralytic ileus)—Should not be used in patients with these conditions.

Diabetes or
Heart rhythm problems or
Hypotension (low blood pressure) or
Pancreatitis (swelling of the pancreas) or
Pheochromocytoma or
Seizures or epilepsy, history of—Use with caution. May make these conditions worse.

Kidney disease or
Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use of This Medicine:

A doctor or other trained health professional will give you this medicine in a hospital. This medicine is given as a shot into a muscle or into a vein.

Precautions While Using This Medicine:

It is very important that your doctor check your progress while you are using this medicine to see if the medicine is working properly and to decide if you should continue to use it. Blood and urine tests may be needed to check for unwanted effects.

Do not use this medicine if you are using or have used an MAO inhibitor (MAOI) (eg, isocarboxazid [Marplan®], linezolid [Zyvox®], phenelzine [Nardil®], selegiline [Eldepryl®], tranylcypromine [Parnate®]) within the past 14 days.

Do not use too much of this medicine or use it more often than your doctor tells you to. This can be life-threatening. Signs of an overdose include: change or loss of consciousness, cold, clammy skin, coughing that sometimes produces a pink frothy sputum, decreased awareness or responsiveness, extreme dizziness or weakness, increased sweating, irregular, fast, or slow, or shallow breathing, pale or blue lips, fingernails, or skin, sleepiness or unusual drowsiness, slow heartbeat, seizures, swelling in legs and ankles, or trouble breathing. Call your doctor right away if you notice these symptoms.

This medicine will add to the effects of alcohol and other central nervous system (CNS) depressants. CNS depressants are medicines that slow down the nervous system, which may cause drowsiness or make you less alert. Some examples of CNS depressants are antihistamines or medicine for hay fever, allergies, or colds, sedatives, tranquilizers, or sleeping pills, prescription pain medicine or narcotics, barbiturates or seizure medicines, muscle relaxants, or anesthetics (numbing medicines), including some dental anesthetics. This effect may last for a few days after you stop using this medicine. Check with your medical doctor or dentist before taking any of the above while you are receiving this medicine.

This medicine may be habit-forming. If you feel that the medicine is not working as well, do not use more than your prescribed dose. Call your doctor for instructions.

This medicine may cause sleep-related breathing problems (eg, sleep apnea, sleep-related hypoxemia). Your doctor may decrease your dose if you have sleep apnea while using this medicine.

Using this medicine while you are pregnant may cause neonatal withdrawal syndrome in your newborn babies. Tell your doctor right away if your baby has an abnormal sleep pattern, diarrhea, a high-pitched cry, irritability, shakiness or tremors, weight loss, vomiting, or fails to gain weight.

Call your doctor right away if you have worsening of pain, increased sensitivity to pain, or new pain after taking this medicine. These may be symptoms of opioid-induced hyperalgesia and allodynia.

This medicine may cause a serious condition called serotonin syndrome when taken with certain medicines. Check with your doctor first before you take any other medicines. Call your doctor right away if you have a fever, confusion, restlessness, loss of coordination, or diarrhea.

This medicine may cause adrenal gland problems. Check with your doctor right away if you have darkening of the skin, diarrhea, dizziness, fainting, loss of appetite, mental depression, nausea, skin rash, unusual tiredness or weakness, or vomiting.

Dizziness, lightheadedness, or fainting may occur, especially when you get up suddenly from a lying or sitting position. Getting up slowly may help. Also, lying down for a while may relieve dizziness or lightheadedness. If this problem continues or gets worse, check with your doctor right away.

Do not change the dose or suddenly stop taking this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. This may help reduce the possibility of withdrawal symptoms, including anxiety, restlessness, fever or chills, joint pain, nausea or vomiting, loss of appetite. runny nose, stomach cramps, sweating, tremors, or trouble with sleeping.

This medicine may cause some people to become dizzy, lightheaded, faint, drowsy, or less alert than they are normally. Do not drive or do anything else that could be dangerous until you know how this medicine affects you. Getting up slowly from a lying or sitting position may also help.

This medicine may cause a serious allergic reaction called anaphylaxis and angioedema, which can be life-threatening and require immediate medical attention. Call your doctor right away if you have a rash, itching, hoarseness, large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.

Using narcotics for a long time can cause severe constipation. To prevent this, your doctor may direct you to take laxatives, drink a lot of fluids, or increase the amount of fiber in your diet. Be sure to follow the directions carefully, because continuing constipation can lead to more serious problems.

Using too much of this medicine may cause infertility (unable to have children). Talk with your doctor before using this medicine if you plan to have children.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

Incidence not known: Agitation; anxiety; blurred or loss of vision; chest pain, discomfort, or tightness; chills; cold sweats; coma; confusion; cool, pale skin; cough; darkening of the skin; decrease blood pressure; deepening of voice; diarrhea; difficulty in speaking; difficulty swallowing; disturbed color perception; dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position; double vision; drooling; dysphoria; false or unusual sense of well-being; fast, pounding, or irregular heartbeat or pulse; fever; halos around lights; headache; hives, itching, skin rash; increase blood pressure; increased hair growth; increased hunger; increased muscle mass; increased sensitivity to pain; loss of appetite; loss of balance control; mental depression; muscle trembling, jerking, or stiffness; nausea; nervousness; nightmares; night blindness; overactive reflexes; overbright appearance of lights; poor coordination; puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue; restlessness; redness to the face; seeing, hearing, or feeling things that are not there; seizures; shakiness; shakiness in the legs, arms, hands, and feet; shivering; shuffling walk; slow or irregular heartbeat; slurred speech; stiffness of the limbs; sweating; talking or acting with excitement you cannot control; trembling or shakiness of the hands or feet; trouble breathing; tunnel vision; twisting movements of the body; twitching; uncontrolled movements, especially of the face, neck, and back; uncoordinated muscle movements; unusual tiredness or weakness; vomiting; worsening of pain

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose: Anxiety; blurred vision; change or loss of consciousness; chest pain or discomfort; chills; cold, clammy skin; cold sweats; coma; confusion; constricted pupils; cool, pale skin; coughing that sometimes produces a pink frothy sputum; difficult or trouble breathing; headache; increased hunger; increased sweating; irregular, fast or slow, or shallow breathing; lightheadedness, dizziness or fainting; nausea; nervousness; nightmares; pale or blue lips, fingernails, or skin; seizures; shakiness; sleepiness or unusual drowsiness; slow or irregular heartbeat; slurred speech; swelling in the legs and ankles; trouble breathing

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Incidence not known: Constipation; decrease in frequency of urination; decrease in urine volume; difficulty in passing urine (dribbling); dry mouth; increased sensitivity of the skin to sunlight; pain at the injection site; redness or other discoloration of the skin; severe sunburn; painful urination

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Last Updated: 4/24/2024

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