Factors impacting variability of the urinary normeperidine-to-meperidine metabolic ratio in patients with chronic pain

Abstract

Meperidine (Demerolw) is a mu- and kappa-opiate receptor agonist used for moderate to severe pain. Overdose can result in respiratory depression, hypotension and coma, while accumulation of its toxic metabolite, normeperidine, can cause delirium and seizures. Little data exist examining the inter- and intrasubject variability of the normeperidine- to-meperidine metabolic ratio (MR) in urine. This retrospective data analysis examined meperidine and normeperidine urine concentrations collected from chronic pain patients. In 98 subjects with multiple visits, the geometric mean urinary MR 5 6.1 (coefficient of variation, %CV 5 68%). From single specimens obtained from 799 subjects, the geometric mean urinary MR 5 6.2 (%CV 5 212%). The urinary MR increased in young subjects compared with elderly (P 5 0.004) and middle-aged subjects (P 5 0.01). A 27% difference was found between the male and female urinary MR (tantial variability in meperidine metabolism and the serious side effects of its metabolite normeperidine require greater vigilance in patient medication monitoring. © The Author [2013]. Published by Oxford University Press. All rights reserved.