Meperidine and Selective Serotonin-Reuptake Inhibitors

Abstract

Meperidine is one of the most commonly used opioid for the relief of acute pain. However, this full opioid-agonist may also cause several adverse effects related to its pharmacological actions, including the less-recognized serotonin syndrome. Theoretically, through blocking presynaptic serotonin reuptake, meperidine may induce or interact with other serotonergic agents and result in serotonin hyperstimulation. There is an increased risk for serotonin syndrome in susceptible individual or in patients with two or more serotonin reuptake-inhibiting medications used together. Sometimes, medications like meperidine are not immediately identified as serotonergic, and are added to a patient's regimen for analgesia. Serotonin syndrome is serious and poses a potentially life-threatening risk. Cautious prescription of meperidine and heightened physician awareness of this syndrome may prevent unexpected complications. Clinicians may underestimate the potential for selective serotonin reuptake inhibitors (SSRTs) and newer serotonergic medications to cause serious morbidity. Serotonergic agents should not be used with meperidine-type analgesics to avoid the potential consequences. Morphine has no serotonergic property, therefore should be considered as an alternative analgesic.