From the Guidelines
Meperidine is not recommended for the management of dyspnea, and instead, morphine is the preferred opioid for treating dyspnea, particularly in palliative care settings. For dyspnea management, low-dose morphine starting at 2.5-5mg orally every 4 hours as needed, or 1-2mg IV/SC for more severe symptoms, is typically used 1. Meperidine has several disadvantages that make it unsuitable for dyspnea treatment, including a shorter duration of action requiring more frequent dosing, accumulation of the neurotoxic metabolite normeperidine which can cause seizures (especially with renal impairment or repeated dosing), and significant drug interactions with MAOIs and SSRIs. Additionally, meperidine has more anticholinergic side effects and less reliable respiratory depression relief compared to morphine.
Key Points
- Morphine is the preferred opioid for treating dyspnea, particularly in palliative care settings 1.
- Low-dose morphine starting at 2.5-5mg orally every 4 hours as needed, or 1-2mg IV/SC for more severe symptoms, is typically used 1.
- Meperidine has several disadvantages that make it unsuitable for dyspnea treatment, including a shorter duration of action and accumulation of the neurotoxic metabolite normeperidine 1.
- Other opioid alternatives for dyspnea include hydromorphone, oxycodone, or fentanyl, particularly in patients with morphine allergies or renal impairment 1.
Opioid Alternatives
- Hydromorphone, oxycodone, or fentanyl may be used as alternatives to morphine for dyspnea management, particularly in patients with morphine allergies or renal impairment 1.
- The choice of opioid alternative should be based on individual patient needs and medical history.
Non-Pharmacological Interventions
- Non-pharmacological interventions, such as breathing training, neuro-electrical leg muscle stimulation, or use of a hand-fan and walking-aids, may be considered as adjunctive treatments for dyspnea 1.
- Relaxation, breathing-relaxation training, and psychological interventions can also be tried to help manage dyspnea.
Conclusion is not allowed, so the answer will be ended here.
From the Research
Meperidine for Dyspnea
- There is limited evidence to support the use of meperidine for dyspnea, with most studies focusing on other opioids such as morphine and fentanyl 2, 3, 4.
- Meperidine is a synthetic opioid analgesic that has been used to treat pain, but its use is often limited due to its poor oral bioavailability and potential for toxicity 5.
- In older adults, meperidine use has declined over time, but the remaining use appears to be decreasing in safety, with more meperidine prescribed per user 6.
- The Institute for Safe Medication Practices has suggested avoiding meperidine in older adults, limiting its dose, and duration of use due to its potential for neurotoxicity and accumulation of normeperidine 6.
- There are no studies that specifically investigate the use of meperidine for dyspnea, and its use for this indication is not recommended due to the availability of safer and more effective alternatives 2, 3, 4.