Bashing Demerol

For good reason. Both Shadowfax and ER Stories write about the addictive potential of this narcotic, and how there is really no positive indication for its use.

Comments

Michael Rack, MD
I agree with not using demerol for migraines.
When I was a resident, it was the drug of choice for pancreatitis, due to the theoretical possibility of sphincter of oddi dysfunction with morphine- what’s the current thinking on this?
Anonymous
Demerol is useful in severe refractory rigors. Talk with your ID or onc docs kevin.
The Happy Hospitalist
I have patients all the time that say demerol is the only medication that works. Of course it is.
shadowfax
Yes, Demerol is good for rigors — fortunately, that’s not a common problem in the ER.
The “anti-spasmodic” properties of demerol were always sketchy at best and have been pretty well debunked.
Cheers,
SF
Anonymous
Agreed, very bad drug for pain. The old demerol/vistaril combo request is a dead giveaway.
One interesting factoid I’ve heard: meperidine was originally synthesized by Nazis in the early days of WWII. Unlike other opioids, I’ve been told it’s an atropine derivative whose synthesis didn’t require access to poppy fields (which were blockaded by the Allies).
Anybody know if this story is actually true? Can’t find a ton on the net other than one guy who seems to know a lot about opioid synthesis by Hoechst Pharmaceuticals in the late 1930s:
http://www.bluelight.ru/vb/archive/index.php/t-257715.html
Interestingly, methadone seems to have a similar history.
Anonymous
Agreed SF, but remember some of us docs are working outside the ER. Blankets statements about a drug being of “no positive indication” show that one has never had significant experience with say an AML undergoing induction who may be septic and is rigoring up a storm.
Food for thought.
Anonymous
Demerol seemed to be of some use in stopping the shivers, or rigors, that you see on emergence from anesthesia. Not sure how well that’s been studied.

Bashing Demerol

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