Demerol (meperidine) is still legally available in the United States, but its use has dropped dramatically over the past two decades. The brand-name Demerol tablet has been discontinued from the market, though generic meperidine remains available in both tablet and injectable forms from several manufacturers. You’re unlikely to encounter it in most modern pain management settings, but it hasn’t been pulled for safety reasons and can still be prescribed.
Brand-Name Demerol vs. Generic Meperidine
The brand-name Demerol 100 mg tablet, originally marketed by Quagen Pharmaceuticals, is listed in the FDA’s “Discontinued Drug Product List.” The FDA formally determined that this product was not withdrawn for safety or effectiveness reasons. The company simply stopped marketing it. This distinction matters because it means the FDA will continue approving generic versions of the drug.
Several companies still manufacture generic meperidine. Hikma Pharmaceuticals produces injectable solutions, oral solutions, and tablets. Epic Pharma and Genus Lifesciences make tablets. Hospira still produces a Demerol-branded injectable solution used in hospitals. So while you won’t find a box labeled “Demerol” at a pharmacy counter, the same drug under its generic name is still on the market.
Why Hospitals Rarely Use It Now
Meperidine was once one of the most commonly prescribed opioid painkillers, especially after surgery. That changed as evidence mounted about a serious problem: when your body breaks down meperidine, it produces a byproduct called normeperidine that is toxic to the nervous system. This metabolite can cause muscle twitching, agitation, and seizures. Unlike the pain relief from meperidine (which wears off relatively quickly), normeperidine builds up in the body over hours and days, especially in people with kidney problems.
The seizure risk isn’t limited to high doses or prolonged use. Cases of muscle jerking and seizures have occurred in patients with normal kidney function taking moderate doses for as few as three days. The Department of Veterans Affairs identifies renal dysfunction, high or frequent dosing, and use alongside medications that lower the seizure threshold as key risk factors for this neurotoxicity.
Meperidine is also a weaker painkiller than many people realize. To match the effect of 10 mg of injectable morphine, you need 75 mg of injectable meperidine. For oral doses, the gap widens further: 300 mg of oral meperidine equals just 30 mg of oral morphine. This means patients need large, frequent doses to manage significant pain, which increases the chance of normeperidine accumulating to dangerous levels.
Hospital pharmacy data reflects the shift away from this drug. One study tracking surgical departments found that nearly half of surgical patients received meperidine in 2008. After a pharmacist-led initiative to reduce its use, that rate dropped to about a third within a year. Many hospitals have since gone further, removing meperidine from their formularies entirely or restricting it to a handful of specific situations.
The Few Situations Where It’s Still Used
Meperidine has a unique property that keeps it from disappearing completely: it’s unusually effective at stopping shivering. Post-anesthesia shivering is common after surgery, and meperidine works better for this than other opioids. In this role, only a single small dose is typically needed, which avoids the normeperidine buildup that makes repeated dosing dangerous.
It also still has a role in treating rigors, the intense, uncontrollable shaking that can occur during certain medical infusions. Some hospital protocols use meperidine as a backup when other medications fail to stop rigors. In one documented case, a patient receiving a cancer drug who didn’t respond to two doses of morphine had their shaking stop after a single small dose of meperidine.
Who Should Not Take It
Meperidine carries a strict contraindication with a class of antidepressants called MAOIs. Taking the two together, or taking meperidine within 14 days of stopping an MAOI, can trigger serotonin syndrome, a potentially fatal condition involving dangerously high levels of serotonin in the brain.
The risk of serotonin syndrome extends beyond MAOIs. Common antidepressants like SSRIs and SNRIs, migraine medications (triptans), the herbal supplement St. John’s wort, and even some muscle relaxants can all interact with meperidine to elevate serotonin to dangerous levels. Given how widely prescribed antidepressants are, this interaction alone rules out meperidine for a large portion of the population.
The American Geriatrics Society includes meperidine on the Beers Criteria, a list of medications considered inappropriate for older adults. The specific concerns are neurotoxicity and delirium. Older adults tend to have reduced kidney function, which slows the clearance of normeperidine and amplifies the risk of seizures and confusion. The Institute for Safe Medication Practices issued a bulletin in 2007 calling for avoidance of meperidine in older patients and those with kidney problems.
Prescribing Restrictions
Meperidine is classified as a Schedule II controlled substance by the DEA, placing it in the same category as oxycodone, fentanyl, and morphine. This means prescriptions cannot be called in to a pharmacy in most states, refills are not allowed, and there are strict record-keeping requirements for every dose dispensed. If a doctor does prescribe it, you’ll need a new written or electronic prescription each time.
In practice, most physicians trained in the last 15 to 20 years have little reason to prescribe meperidine for pain. Safer opioids with longer durations of action, fewer dangerous metabolites, and better-understood safety profiles have replaced it in nearly every clinical scenario where it was once standard. The drug remains legally available, but it occupies a tiny and shrinking corner of modern medicine.