CENTRAL-NERVOUS-SYSTEM TOXICITY ASSOCIATED WITH MEPERIDINE USE IN HEPATIC-DISEASE

Meperidine-associated central nervous system (CNS) excitatory toxiciti es are believed to be caused by accumulation of the active metabolite normeperidine. Normeperidine is eliminated by the kidneys and accumula tes in patients with renal insufficiency, sickle cell disease, and can cer. In patients with cirrhosis, the metabolism of meperidine is decre ased, leading to accumulation of the parent drug and possible CNS depr essive effects similar to hepatic encephalopathy. Although the elimina tion of normeperidine is decreased as well in these patients, the rati o of normeperidine to meperidine is generally low, and the narcotic ef fects of meperidine usually predominate. This is the first reported ca se of CNS excitatory toxicities in a patient with alcoholic hepatitis and cirrhosis, and normal renal function. Administration of multiple d oses of meperidine in patients with hepatic disease should be discoura ged.