Variability in Intramuscular Meperidine Absorption
26. M.T. achieved excellent analgesia from the first dose of meperidine 50 mg IM, but she started to complain that subsequent doses produced variable pain relief, and she accused the nurse of giving her placebos. What are some of the explanations for this problem?
The most common cause of variable clinical response after an IM meperidine injection is erratic bioavailability after repetitive injections at the same site. The absorption of meperidine from an injection can vary by as much as 30% to 50% after repeated IM administrations. Other considerations include tachyphylaxis, progression of an underlying disease (e.g., in patients with cancer), and the possibility of opioid diversion by the patient or someone else through dilution or removal of active drug from its container.
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