1. Dismiss Notice
  2. Download free Tapatalk for iPhone or Tapatalk for Android for your phone and follow the SDN forums with push notifications.
    Dismiss Notice
  3. Hey Texans—join us for a DFW meetup! Click here to learn more.
    Dismiss Notice

Demerol - have it? Use it?

Discussion in 'Emergency Medicine' started by Apollyon, Dec 19, 2008.

?

Is Demerol available in your hospital? Do you use it?

  1. No. Not available.

    15 vote(s)
    41.7%
  2. Yes, but limited to specific services (if the ED is one, please mention that in the comments).

    2 vote(s)
    5.6%
  3. Yes, and I use it regularly for patient analgesia.

    0 vote(s)
    0.0%
  4. Yes, and I never (or virtually never) use it.

    19 vote(s)
    52.8%
  1. Apollyon

    Apollyon Screw the GST
    Physician Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Nov 24, 2002
    Messages:
    19,261
    Likes Received:
    3,661
    Is Demerol available in your hospital? When I was at Duke, the only indication is for post-op shivering. That's it. It's limited to anesthesia. Where I am now, though, I asked the medical director not if, but when meperidine would be dropped from the formulary. He said later (after a P&T meeting) that the old guys liked it too much, and that it wasn't going anywhere.

    So, my question: do you have it, is it limited to specific services, and do you use it?
     
  2. Note: SDN Members do not see this ad.

  3. dchristismi

    dchristismi Gin and Tonic
    10+ Year Member

    Joined:
    Dec 4, 2003
    Messages:
    987
    Likes Received:
    319
    Status:
    Attending Physician
    My medical school hospital pulled it from the formulary.
    My residency hospital I believe only used it in anesthesia shivering. (Not in ED)
    My real job, well, we don't have it, but I try to avoid going upstairs so I don't know if the gas passers use it.
     
  4. Arcan57

    Arcan57 Junior Member
    10+ Year Member

    Joined:
    Nov 21, 2003
    Messages:
    2,804
    Likes Received:
    1,161
    Status:
    Attending Physician
    We have it available, but the only time I've ever given it is for sickle cell patients that had it as part of their treatment protocol.
     
  5. southerndoc

    southerndoc life is good
    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Jun 6, 2002
    Messages:
    11,680
    Likes Received:
    577
    Status:
    Attending Physician
    Not on the formulary at my primary hospital, and is on the formulary at my part-time hospital but it's not in the ED Pixis.
     
  6. kungfufishing

    kungfufishing Senior Member
    7+ Year Member

    Joined:
    Mar 7, 2003
    Messages:
    1,053
    Likes Received:
    5
    Status:
    Attending Physician
    Have it, have given it once in the past 6 months.
     
  7. docB

    docB Chronically painful
    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Nov 27, 2002
    Messages:
    7,742
    Likes Received:
    211
    Status:
    Attending Physician
    My 5 hospitals all banned it from the EDs. It can be used in the rest of the hospitals. It was puerly to discourage the seekers. It worked for a while. Now everyone just asks for Dilaudid.
     
  8. EM OR BUST

    5+ Year Member

    Joined:
    Mar 18, 2007
    Messages:
    271
    Likes Received:
    1
    Status:
    Resident [Any Field]
    We dont have it. I have myself received it once for kidney stones, loved it:)
     
    #7 EM OR BUST, Dec 21, 2008
    Last edited: Dec 21, 2008
  9. Spunky Monkey

    2+ Year Member

    Joined:
    Jan 16, 2007
    Messages:
    17
    Likes Received:
    0
    Enough pain meds to choose from without worrying about demerol.
     
  10. ZincFingers

    ZincFingers HI EVERYONE!!1!
    5+ Year Member

    Joined:
    Feb 24, 2006
    Messages:
    104
    Likes Received:
    2
    Status:
    Resident [Any Field]
    This is the case with my primary hospital. Dilaudid has become the drug of choice.

    At the rural hospital where I've been rotated to, they like Demerol a lot. But interestingly, Lortab is the primary abuse problem down here.
     
  11. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
    Moderator Physician Faculty 10+ Year Member

    Joined:
    Aug 2, 2006
    Messages:
    9,274
    Likes Received:
    5,091
    Status:
    Attending Physician
    Got to aggravate a seeker the other day for this.

    Pt: I got's migraines.
    Me: For how long
    Pt: Long as I can remember
    Me: So what do you take for it at home
    Pt: Nothin'
    Me: What do they do for you at the hospital
    Pt: I get Demerol.
    Me: I can't give you that.
    Pt: Why not?!?
    Me: It isn't carried by the hospital because people would come in asking for it
    Pt: Oh.....
    Pt: Can I have some Dilaudid? I'm allergic to Reglan, Toradol, and Phenergan.
     
  12. drmwvr

    7+ Year Member

    Joined:
    Dec 2, 2008
    Messages:
    477
    Likes Received:
    183
    Status:
    Non-Student
    This is an interesting thread. My understanding of the demerol issue is that the hospital based pharmacy sages became concerned with the metabolite, normeperidine, in older patients with decreased cr. cl.(read: Those who could be assumed for same) and the potential for neurotoxicity. Never heard of the "seeker" angle. Granted, there are plenty other of opiates that work well, but what gets under my saddle is taking away a perfectly legitimate option for analgesia. Will they remove toradol for similar reasons? I don't know how much droperidol was used in the A and E here, but THAT is a perfect example of a pharmacist taking risk out of context and dictating practice (it has been taken off of many if not most formularies in the states). Excellent drug for PONV. Gone.
     
  13. Apollyon

    Apollyon Screw the GST
    Physician Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Nov 24, 2002
    Messages:
    19,261
    Likes Received:
    3,661
    Then you aren't in the US. As you use the term "A and E", I think that that adds to it. Meperidine gives a sensation of euphoria, as does Phenergan IV. That euphoria is irrespective of analgesia.
     
  14. drmwvr

    7+ Year Member

    Joined:
    Dec 2, 2008
    Messages:
    477
    Likes Received:
    183
    Status:
    Non-Student

    Morphine and dilaudid produce no euphoria? Are they next on the seeker list? (I am in the US, not in EM. "A&E" a bit of a relflex)
     
  15. docB

    docB Chronically painful
    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Nov 27, 2002
    Messages:
    7,742
    Likes Received:
    211
    Status:
    Attending Physician
    The degree of euphoria created by Demerol created real problems for us. Dilaudid is less of an issue but it has a similar following. Morphine even less so than Dilaudid.

    As for Toradol I'm not a big fan of it. High nephrotoxicity and cost but similar effect as Motrin. Unless the patient can't tolerate po I just give Motrin. The fact that many patients believe that Toradol is better than Motrin because real pain relief can only come in a shot just shows the subjectivity of the whole issue.
     
  16. Apollyon

    Apollyon Screw the GST
    Physician Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Nov 24, 2002
    Messages:
    19,261
    Likes Received:
    3,661
    You know what, dreamweaver? You have at it. Even though you've never heard of the drug seekers wanting Demerol, the drug seekers have, and give it liberally, and don't wonder why you're neck-deep in back pain and dental pain and headaches.

    I find it interesting that you would defend meperidine, especially with several other options available. What is telling is that you haven't voted in the poll (or, if you have, your vote does not represent what you are posting, which means you are strictly being argumentative).
     
  17. drmwvr

    7+ Year Member

    Joined:
    Dec 2, 2008
    Messages:
    477
    Likes Received:
    183
    Status:
    Non-Student

    I'm disappointed in my communication skills that you took my first post to be a defense, per se, of demerol. I can take it or leave it. Most often, I leave it. The intent was to publicly lament the ability of a non-physician (pharmacists) to dictate a medical decision. I used demerol and droperidol as two examples. I of course am familiar with seeking behavior with narcotics in general, not just demerol. I was just under the impression that it had been made unavailable based on the belief that normeperidine neurotoxicity was a bigger problem than it is, not opiate seeking behavior. I have voted in the poll; I chose the last statement.
     
  18. bulgethetwine

    bulgethetwine Membership Revoked
    Removed 10+ Year Member

    Joined:
    Jan 4, 2005
    Messages:
    781
    Likes Received:
    2
    We don't have it at our hospital. I think most in the state (New York) have it under the guise of anesthesia, though.
     
  19. drmwvr

    7+ Year Member

    Joined:
    Dec 2, 2008
    Messages:
    477
    Likes Received:
    183
    Status:
    Non-Student
    Thanks for the clarification. The reality for me is (I'm an anesthesiology visitor) that when I give any longer lasting opiate such as morphine or dilaudid, it is most usually with real euphoria inducers such as sufentanil or fentanyl. Add versed and propofol and everyone is quite stoned. While these shorter acting agents are frequently close to being "gone" once the patient is awake, it is difficult to attribute the euphoria to any one agent. I do favor dilaudid, as it seems to make healthy patients almost giddy after having been carved upon.
     
  20. docB

    docB Chronically painful
    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Nov 27, 2002
    Messages:
    7,742
    Likes Received:
    211
    Status:
    Attending Physician
    I think you have a valid point about not having pharmacy dictate prescribing practices. I certainly echo your point about droperidol. However in most of the cases I'm aware of where Demerol was restricted it was not due to pharmacy, it was due to the EDs wanting it gone.

    The issues about the metabolite toxicity tended to cause restrictions to the inpatient use such as saying patients shouldn't be on PRN Demerol for more than 48 hours or restricting the dosage. The toxicity issue didn't cause much concern in the EDs because we usually only give a few doses.
     
  21. southerndoc

    southerndoc life is good
    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Jun 6, 2002
    Messages:
    11,680
    Likes Received:
    577
    Status:
    Attending Physician
    I just love it when the seekers come in requesting their typical cocktail. Dilaudid, Phenergan, and Benadryl -- all requested to be pushed fast "because that's the only way it works." When they ask for it to be administered fast, I give it to them individually and over 10 mins in a 100 mL normal saline mixture.
     
  22. Apollyon

    Apollyon Screw the GST
    Physician Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Nov 24, 2002
    Messages:
    19,261
    Likes Received:
    3,661
    Fair enough. I'm sorry if I sounded like I was on the offensive. You see it from the back end, whereas we see it from the front end.

    And southerndoc is right on target with the slow infusion, as I too have indeed heard the "it only works if you shoot it in" Dilaudid statement.
     
  23. Pharmavixen

    Pharmavixen foxy pharmacist
    7+ Year Member

    Joined:
    Jan 20, 2008
    Messages:
    1,043
    Likes Received:
    14
    Status:
    Pharmacist
    Generally, we gently suggest rather than dictate.

    Formulary decisions are a collaboration between medicine and pharmacy. Besides, if we tried to dictate to you guys, you'd tell us to get stuffed.

    You're dead-on about the neurotoxicity of the metabolite. After my surgery, I remember walking with the IV pole, staring at the floor, as the speckled tile pattern seemed to swirl around my feet with each step. Pretty awesome.
     
  24. SoCuteMD

    10+ Year Member

    Joined:
    Nov 28, 2005
    Messages:
    8,680
    Likes Received:
    718
    Status:
    Attending Physician
    I have to say that I've rarely seen pharmacy "dictate" anything. I am grateful for any input from the pharmacy, as they know drugs far better than I ever will. I know that anesthesiology has this love/hate relationship with other providers, but please don't bring it over here to the EM forum.
     
  25. southerndoc

    southerndoc life is good
    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Jun 6, 2002
    Messages:
    11,680
    Likes Received:
    577
    Status:
    Attending Physician
    Most of the time it's not a pharmacist that dictates what is available in the hospital. Most hospitals have P&T committees (pharmacy and therapeutics) that are composed of physicians, pharmacists, nurses, etc. The committee decides what meds are on formulary.
     
  26. drmwvr

    7+ Year Member

    Joined:
    Dec 2, 2008
    Messages:
    477
    Likes Received:
    183
    Status:
    Non-Student

    Quite right here. Apologies all around, especially to our pharmacy contributors. I left a broad swath, with pharmacy in the way and it wasn't fair. That said, the way it happened where I am was with what I considered an overly zealous dept of pharmacy influence. P&T was precisely the mechanism but we felt that our use of the drug (droperidol) was not taken into consideration. Meetings were called at 0730, which is when we're placing our patients on the table. We felt somewhat "rail roaded". When demerol was on the block, we resolved to not let the same thing happen and were successful in retaining it. In retrospect, it would have been a silly hill to "die on", but it was felt that were we to aquiesce on this point, we'd regret it again. So there.
     
  27. Pharmavixen

    Pharmavixen foxy pharmacist
    7+ Year Member

    Joined:
    Jan 20, 2008
    Messages:
    1,043
    Likes Received:
    14
    Status:
    Pharmacist
    No worries :)

    Sounds like maybe you were having to deal with jerks.
     

Share This Page