Meperidine

The DEA classified meperidine as a Schedule II controlled substance in 1970, a classification that remains in effect. The WHO removed meperidine from its List of Essential Medicines in 2003. The death of Libby Zion from a meperidine-phenelzine interaction became a landmark case that triggered national reforms in medical education. Meperidine was once the most widely used opioid in the United States, initially regarded as safer than morphine based on mid-20th century research. The 2023 American Geriatrics Society Beers Criteria issued a strong recommendation to avoid meperidine in older adults. Meperidine produces a neurotoxic metabolite, normeperidine, which accumulates at elevated concentrations. Meperidine carries a risk of serotonin syndrome when co-administered with MAOIs or SNRIs.