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demerol? Please explain.


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Old 09-22-2005, 02:38 PM   #1
Skylar333
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demerol? Please explain.

What exactlly is demerol? The nurse told me it was a narcotic. But besides that how is it related in strength to morphine, vicodin, or codeine? I was prescribed vicodin a while back and know how that is when it comes to my migraines. Pretty useless. I am 26 weeks pregnant and suffer from severe migraines. After not having one for awhile I got a really bad one yesterday and a MD had me hooked up to an IV of phenergan (anti-nausia) and 25mg of demerol. I know this stuff is strong because it made me loopy and took away my migraine for the time being. I posted on the headache board but wanted some advice on this medication. Thanks in advance.

 
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Old 09-22-2005, 02:48 PM   #2
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Re: demerol? Please explain.

i found over the years that demerol is the only thing that works for me with severe pain. teeth,back,neck and after surgeries. i have a reaction to everything else. it is safe for your baby also. i don't know if they still do but dr.s used to give you a shot in labor.

 
Old 09-22-2005, 06:04 PM   #3
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Re: demerol? Please explain.

Hi Skylar,

The dose that the Dr. gave you is getting towards the high-average dose when taken IV as opposed to IM. Adding the Phenergen to it makes the dose of Demerol more potent. Usually - at least what I've seen - it is given IM.

It isn't a medication that should be taken daily for a few reasons.

It is a man made medication (compared to morphine or codeine etc.) and it was actually developed by the Germans during world war 2 because they were afraid that they didn't have enough morphine for wounded soldiers.

Good luck!!//Chaz

 
Old 09-22-2005, 07:09 PM   #4
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Re: demerol? Please explain.

Hey Chas,

What have you been smoking?? LOL 25mgs of Demerol is a baby dose....a dose can vary from 25mg-150mg. Sometimes, it is even higher. Depends on how tolerant you are. So 25mgs, is definitely on the small end. It can be given either IV or IM, just depends on the doc and how fast you need pain relief. Obviously, IV is pretty instant, whereas, IM takes at least 30 minutes (sometimes, IV still isn't fast enough LOL). It is usually not given on a daily basis for a couple of reasons. It is poorly absorbed orally and it has toxic metabolites that build up. When taken on a daily basis, these metabolites build up and can cause all kinds of problems. Just because it is a synthetic drug has nothing to do with why it's not given on a daily basis. If that were the case, say goodbye to Methadone, Fentanyl, Oxycodone, Hydromorphone, and Hydrocodone.

Also, Methadone was developed by the Germans to substitue for Morphine, not Demerol. You have one piece of info right...phenergan does increase the effects of Demerol, or any other narc. Sorry, you have two pieces right...Demerol is a synthetic drug.

Take care

Last edited by friendly_one; 09-22-2005 at 09:17 PM.

 
Old 09-23-2005, 05:47 AM   #5
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Re: demerol? Please explain.

I too was almost certain of the methadone being developed by the germans and not demerol.thanks for taking away at least 'some' of my confusion.I also was not aware that demerol is actually a man made synthetic.i had always assumed,i guess from the strength that it was kind of an offshoot of MS.learn something new everyday.Marcia

i would think it would actually be much safer to use MS vs Demerol for PG women with extreme pain?i know i was given MS during the last tri of my last PG when i had gone into early labor.I did not actually give birth until a month later.And yes I was having labor pains every single day til that day on a 24/7 basis.My THAT was fun.Just incase you are worried Sky,I do think that this one time only demerol would not cause any major problems for your baby.i have been trying to remember just what in the heck they Rxed me for my migranes during my pregnancies as i too used to get migranes all the time back then.i only actually had one during each of my two pregnancies and both of them popped in during both PGs at the beginning of the second trimesters.But those two migranes were the absolute worst two ever with regards to incredibly different 'auras" than the norm for me.in my first PG i actually totally lost vision in one eye for about five hours,i mean everything went totally black in that eye but all was well the next day.i know I could not use my normal med Midrin for the headaches as it was wayy too new and they did not know of any real proven risks to the baby.hopefully you wont have anymore.I also experienced another migrane(again with the very different auras)exactly one month after giving birth to both of my boys.I do feel that the post PG migranes were also hormone related like the ones i had in the beginning of the 2nd tri,as these were the only headaches(migrane) that i had while PG,thank god.congrats and good luck with the pregnancy,and hopefully you will not have anymore headaches or other complications.Marcia
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Old 09-23-2005, 08:19 AM   #6
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Re: demerol? Please explain.

Tough crowd today, Actually they were both developed at the same time and meth wasn't used because of the variation in response from one patient to the next so they chose to use Demerol. He is correct that given IV, 25 mgs is a large dose. IM is 3 times more potent than oral and IV is 3 times more potent than IM, so that 25 mgs of IV demi is equal to 75 mgs IM or 225 mgs of oral demerol. That is on the high end for a drug that isn't metabolized well and can cause a seizure when used for prolonged periods of time.

Not that your going to find a doc to prescribe demi intended for IV use outside of the hospital anyway. Oraly it's not a potent drug, but IV it's much more potent and effective but has limits as to how long and how much you can safely use.

It's a shame that demi is the only effective med for some, because once you have a seizure they won't keep prescribing it. 300 mgs or oral demi is roughly equal to 30 mgs or oral morphine and only lasts 2-3 hours at best, in that regard I would say oral demi is a weak drug when it takes that much to equal a standard dose of morphine and needs to be repeated every 2-3 hours.

Good luck if your going to argue the safety factor of prescribing large amounts of demi for oral use when pregnant. 6 50mg capsules every 2-3 hours is going to raise eyebrows at the pharmacy when you have so many other safe choices. Actually Chaz' post was the one not filled with misinformation.

2 drugs can be developed in the same era in the same country, particularly when Most major advances in chemistry and medication made during the mid 20th century were made in germany by the giant industrialist "I G Farben."

IF demi is so potent compared to other meds, why does it take 10 times the number of mgs to equal morphine. It's the only pure opiate that shouldn't be used long term due to risk of seizure but is in the same class of synthetic opiates as fentanyl.

Good luck, Dave
Equianlegesic dosing of demerol
http://www.stat.washington.edu/TALARIA/table11.html

Last edited by Shoreline; 09-23-2005 at 08:30 AM.

 
Old 09-23-2005, 10:19 AM   #7
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Re: demerol? Please explain.

Hi Dave,

We have not "formally" met...So, I'm Shay, nice to meet you. I tend to forget that opioid naive people still exist. LOL In that regard, 25mg IV Demerol would be a fairly high dose. When it comes to Demerol, it is the only thing that helps when my pain spirals out of control. If I'm sick and have an IV, my "standard" dose set up by my pain doc is 150mg Demerol and 25mg Phenergan IV - may repeat dose if needed. If I don't have an IV, then it is 200mg Demerol and 50 mg Phenergan IM - may repeat Demerol dose by half, if needed. (no Phenergan, maxed out on that)

I can be given Morphine and Dilaudid all day, and the pain cycle will not be broken. Demerol, will break the cycle. Strange, huh? When compared to Morphine and Dilaudid, Demerol is very weak. I guess it's like I said before, people react differently to meds.

Anyway, I thought I would introduce myself and say hello. By the way, next week I am being evaluated for an intrathecal pump. If I am a candidate, is Morphine the only drug used? Since Morphine has no effect on me, can Fentanyl be used? I am currently on Fentanyl patches and Actiq.

Take care

Last edited by friendly_one; 09-27-2005 at 03:18 PM.

 
Old 09-23-2005, 11:26 AM   #8
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Re: demerol? Please explain.

Hi Shay, Your choics for the pump are morphine, dilaudid, fentanyl, sufentanyl and prialt. Because fent is what your on it would make the most sense to use. You would also go longer between refills once your dose is set because you talking about micrograms per ml vs miligrams.

Prilat is the non opiate NMDA recptor blocking cone sanail toxin, My clinic hasn't used it yet but it seems you would have to taper off the opoiates to use prialt because it's non opiate and works completely diferently. It's hasn't even been aproved a year yet but is supposed to be 1000 times more potent than morphine. It scares me a bt because it can have severe psych effects on some patients, a about 20% n the last trial had halucinations, disaciative problems and other major side effects similar to those of Ketamine.

They can also use numbng agents like bupivicaine or use Clonodine which reverses some of the changes chronic pain has on nerutransmitters when you compare the the difference between chronic pain and acute pain.

The biggest factor in IT drugs is they have to be preservative free. For whatever reason it seems you respond better to the opiate class that that includes both fdemerol and the fentanyls. There are a couple of other Fents but I'm not sure they can be used IT. There is also Affentanyl and Carfentanyl but they may only be used in anesthesia, Ihaven't met anyone with one of those two fents. Demerol isn't available for pump use but due to concentrations levels it's not a god choice. You would need so much demi compared to othr drugs per ml to find relief and the seizure problem it's just not used.

How far along are you in he trial process and what type of trial are you doing, In patient or single bolus injection? My inpatient trial failed because of a spinal flid leak but the bolus injection went well enoough to have the implant. I'm getting about 50% relief after switching from morphine to dilaudid back in May. It takes lots of tweaking to ge the dose right and when your talking micrograms getting it right from the get go isn't realistic, but it is worth it in the long run. It took 6 months and 16 adjustment to get morphine right, then they switched to dilaudid and that took about 4 months and 7 adjustment to get back to where I was with morphine. So don't be discouraged by it taking time to get the dose right after the implant. Convertng oral micrograms to IT micrograms isn't quite as simplye as converting oral to IM. You may also find that because you experience less side effects with IT meds you may tolerate more without an increase in side effects and get better relief when deliverd IT.
Take care, Dave

Last edited by Shoreline; 09-23-2005 at 11:30 AM.

 
Old 09-24-2005, 03:27 PM   #9
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Re: demerol? Please explain.

Hi Dave,

I haven't even started the trial process yet. I have to go through the psych evaluation first. Was that part of your evaluation as well? My doc said everyone goes through it, at least in his practice. You mentioned Clonidine. I already take that for hypertension. I did not know it is used in IT pumps for chronic pain. Does taking it orally have any benefits for pain? I was put on it merely for hypertension by my PCP. Do you still need breakthrough meds with your pump or can the pump dosage be tweaked for flare ups? If you are taking breakthrough meds, is it markedly decreased from the time when you were on oral meds? I know I have more questions, but that's all I can think of for now. Have a good night!

Take care

Last edited by friendly_one; 09-24-2005 at 09:00 PM.

 
Old 09-24-2005, 11:06 PM   #10
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Re: demerol? Please explain.

Hey PA queen, The cool advantage of the pump is it can be adjusted to manage additional pain if certain times of they day are always worse, like night time or upon rising. But increasing it for a flair up would just continue your tolerance up and at some point you run into intolerqable side effects.

So they set the pumps to manage your standard pain pattern with the goal of relieving 50% of your pain, bttter is great, but hey won't impair you to get better than 50%. My doc does use BT meds. I wouldn't want my pump set to manage my worst pain because I would be over sedated 90% of the time. But I do have different settings for the day Vs the night and morning.

There are some docs that think the pump is a cure all and you shouldn't need BT meds but the only way to acomplish that is to crank it up higher than you need most of the time. I like having that little bit of control from BT meds even if it's just the last 10%. I can skip days of BT meds use and not experience any withdrawal because it's such a small percentage of my daily opiate intake.

I can use what I need when I need it, up to a point. Oxy works best for me and I use anywhere from 15mgs to 60 mgs, Becaue I always have extra I could take more without running out early, but I'm very aware of how oral meds make me feel now that I have a pump, and I like the clear head. IT meds don't cross the blood brain barrier or run systemically through your body.They bind to the thousands/millions of receptors in your spine. So you could toerate alot more equianelgesically without the side effects or impairment when the meds are delivered directly to your spine.

Orals or BT meds compared to your daily amount of IT meds are only going to be a small percentage of the opiates you recieve. Even thogh it may be as little as 20 MCG of fent a ay, It';s so much morepotent IT than any other way, you use considerably less. My pump is set on 5.5 mgs of dilaudid per day. I could take 12 mgs of dilaudid for BT and not touch my pain, but that muc spr4ad over hours works out to be like .230 mgs per hour.

Aqtiq is the most potent BT med you can use and you may be surpprised how well a pump works, but it also may have your tolerance cranked up quite a bit.

It's all trial and error and how you manage side effects. You may handle the side effects or transdermal and transmucosal fent very well and not intrathecally, or vice versa with any med. Different routes of delivery can have completely differnt side effects.

Clonodine does have specific neurotransmiter and calcium channel activity that's effective for CP, but it's unlikely your taking enough orally to make a difference. Same with oral Baclofen. You may get the intended purpose of the drug oraly but not the CP biochemical changes they are trying to achieve.

This article explains a bit about both clonodine and baclofen and their effect on CP and why they are used.

http://www.hosppract.com/issues/2000/07/brook.htm

Good luck with your trial, Dave

Last edited by Shoreline; 09-24-2005 at 11:17 PM.

 
Old 09-30-2005, 03:30 PM   #11
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Re: demerol? Please explain.

Thank you all for educating me. I just got back to this post. Sorry if its kind of late. I personally do not have much experience taking opiates or any other pain meds except for vicodin. I was prescribed Imitrex for my migraines and have yet to need it since the hospital visit and the demerol. So I am not sure if it is useful or not.

 
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