Initial Dosage
Dosage should be adjusted according to the severity of the pain and the response of the patient. While subcutaneous administration is suitable for occasional use, intramuscular administration is preferred when repeated doses are required. If intravenous administration is required, dosage should be decreased and the injection made very slowly, preferably utilizing a diluted solution.
Adults: Initiate treatment in a dosing range of 50 mg to 150 mg intramuscularly or subcutaneously every 3 to 4 hours as needed for pain, and at the lowest dose necessary to achieve adequate analgesia. Elderly patients should usually be given meperidine at the lower end of the dose range and observed closely.
Children: Initiate treatment in a dosing range of 0.5 mg/lb to 0.8 mg/lb intramuscularly or subcutaneously up to the adult dose, every 3 to 4 hours as necessary, and at the lowest dose necessary to achieve adequate analgesia.
Titration and Maintenance of Therapy
Titrate the dose based upon the individual patient’s response to their initial dose of DEMEROL Injection. Individually titrate DEMEROL Injection to a dose that provides adequate analgesia and minimizes adverse reactions. Continually reevaluate patients receiving DEMEROL Injection to assess the maintenance of pain control, signs and symptoms of opioid withdrawal, and other adverse reactions, as well as to reassess for the development of addiction, abuse, or misuse [see Warnings and Precautions (5.1, 5.15)]. Frequent communication is important among the prescriber, other members of the health and care team, the patient, and the caregiver/family during periods of changing analgesic requirements, including initial titration.
If the level of pain increases after dosage stabilization, attempt to identify the source of increased pain before increasing the DEMEROL Injection dosage. If after increasing the dosage, unacceptable opioid-related adverse reactions are observed (including an increase in pain after a dosage increase), consider reducing the dosage [see Warnings and Precautions (5)]. Adjust the dosage to obtain an appropriate balance between management of pain and opioid-related adverse reactions.
Discontinuation of DEMEROL Injection
When a patient who has been taking DEMEROL Injection regularly and may be physically-dependent no longer requires therapy with DEMEROL Injection, taper the dose gradually, by 25% to 50% every 2 to 4 days, while monitoring carefully for signs and symptoms of withdrawal. If the patient develops these signs or symptoms, raise the dose to the previous level and taper more slowly, either by increasing the interval between decreases, decreasing the amount of change in dose, or both. Do not abruptly discontinue DEMEROL Injection in a physically-dependent patient [see Warnings and Precautions (5.15), Drug Abuse and Dependence (9.3)].