Meperidine Hydrochloride and Promethazine Hydrochloride

Drug Class: Meperidine Hydrochloride And Promethazine Hydrochloride > Meperidine Hydrochloride > Meperidine > Fully Synthetic Opioid > Opioids > Opioid Agonist > Analgesic.


Doctors prescribe Meperidine HCl and Promethazine HCl to sedate patients and relieve moderate pain from surgery, having a baby or cancer.

General Drug Information

Physicians Total Care, Inc. offers meperidine HCl and promethazine HCl in a capsule form for oral administration. Each capsule contains 50 mg of meperidine hydrochloride and 25 mg of promethazine hydrochloride and other inactive ingredients. Bottles contain 10, 20, 90 or 100 capsules.


The usual dosage is one meperidine HCl and promethazine HCl capsule every four to six hours as necessary to reduce pain.


Meperidine HCl and promethazine HCl work in different ways to provide relief. Meperidine HCl is an opioid analgesic. It relieves discomfort by depressing the central nervous system, or CNS, to change the way the brain perceives pain messages. Other CNS effects include sedation and a pleasant feeling of euphoria. Meperidine also depresses respiratory centers in the brain to slow breathing.

Meperidine HCl can cause vasodilation, or widening of the blood vessels. This vasodilation may be significant enough to lower blood pressure readings to the point of dangerous hypotension.

Promethazine HCl works as an antihistamine, sedative and anti-emetic. Promethazine works as an antihistamine to reduce itching; it also works as a sedative to help people sleep or calm nerves before a surgical procedure. Promethazine is an anti-emetic, used to ease nausea and vomiting.

When the patient begins meperidine HCl and promethazine HCl therapy, he is opioid-naïve and sensitive to the effects of these drugs. As he continues to use this medication, he grows tolerant of their effects. An opioid-tolerant person requires stronger doses more frequently to achieve the same effects. Doctors should exercise care when increasing dosages to match increased tolerance as raising dosages too quickly can cause adverse actions.


Respiratory Depression

Meperidine HCl depresses respiratory centers in the brain. This respiratory depression results in slow, shallow and irregular breathing patterns that prevent the lungs from adequately exchanging spent carbon dioxide for fresh oxygen. Respiratory depression may cause oxygen starvation and high carbon dioxide levels. Someone suffering from respiratory depression will have inadequate breathing patterns and a bluish tint around the eyes, mouth and fingertips. Respiratory depression is a serious medical condition that may result in death. Attendants should treat respiratory depression as a drug overdose and administer immediate care.

Use in Head Injuries and Increased Intracranial Pressure

Respiratory depression and the resulting high carbon dioxide levels can increase intracranial fluid pressure inside the patient’s skull. Head injuries, brain tumors and pre-existing high intracranial pressure can enhance respiratory depression and increasing intracranial pressure. Furthermore, meperidine HCl can mimic the effects of a head injury, making it more difficult for a doctor to detect the presence or healing process of a head injury. Physicians should use meperidine HCl and promethazine HCl only when necessary in patients with head injury or high intracranial pressure.


Anyone who uses meperidine HCl regularly for more than a few weeks, whether for recreational or therapeutic purposes, can become physically dependent on opioids. An opioid-dependent person experiences withdrawal symptoms when he stops using meperidine HCl abruptly. Physicians should exercise an appropriate degree of caution, similar to morphine, when prescribing meperidine HCl and promethazine HCl preparations. Physicians should consider a non-opioid analgesic for patients with a history of drug or alcohol abuse.

Asthma and Other Respiratory Conditions

Patients suffering from an acute asthma attack, the breathing condition COPD or the heart condition cor pulmonale should exercise extreme caution when using meperidine HCl and promethazine HCl products, as should those with diminished lung capacity or pre-existing respiratory depression, low oxygen levels or high carbon dioxide levels. Even therapeutic doses of meperidine HCl can interfere with breathing in these patients to the point of stopped breathing. Patients with severe breathing problems should not use Meperidine HCl and promethazine HCl outside of monitored locations with oxygen and resuscitation equipment.

Hypotensive Effect

Meperidine HCl may cause severe hypotension in patients already struggling to maintain an adequate blood pressure, either because they have lost a significant amount of blood or because they have received a drug that lowers blood pressure.

Opioids, including meperidine HCl, can cause orthostatic hypotension, or blood pressure that plummets when the patient rises to a standing position quickly.


Meperidine can impair the user’s mental and physical abilities. Consumers should not drive a car or operate heavy machinery until they know how this medication affects them.

Physicians should exercise caution when prescribing meperidine HCl and promethazine HCl combination products to patients with certain types of heart problems.

Meperidine can aggravate seizures in a patient with a history of convulsive disorders. Opioid-naïve patients are at high risk for seizures when dosages exceed the patient’s tolerance, even those patients without a history of seizure disorders.

Meperidine can mask the presence or healing process in patients with acute abdominal conditions. The anti-emetic action of promethazine can obscure the symptoms of other diseases.

Physicians should reduce doses and administer meperidine HCl and promethazine HCl with caution to elderly or debilitated patients and to those with severe liver or kidney problems, Addison’s disease or certain types of thyroid, prostate or urinary problems.


People with a known hypersensitivity to meperidine HCl, promethazine HCl, or other opioids should not use preparations containing these compounds.

Patients who have taken the popular class of drugs known as MAOIs to treat depression or high blood pressure within 14 days should not take meperidine HCl and promethazine HCl. Even therapeutic doses of meperidine could cause unpredictable, severe and sometimes fatal reactions in patients with MAOIs in their systems. Combining meperidine with MAOIs could cause coma, severe respiratory depression, hypotension and a blue color around the patient’s eyes, mouth and fingertips in some patients. Other patients may experience hyper-excitability, seizures, fast heartbeat, high body temperature and high blood pressure. A sensitivity test can reveal whether combining meperidine with an MAOI is safe for a particular individual.

Pregnancy, Labor and Delivery, Breastfeeding

Pregnant women should not use meperidine HCl and promethazine HCl unless the benefits clearly outweigh any possible risks. Scientists have not yet determined how this product might affect the development of the unborn baby.

When used to relieve pain during labor and delivery, meperidine crosses the placental barrier from mother to baby. The baby may suffer withdrawal symptoms or respiratory depression after delivery.

Meperidine passes into human milk. Mothers should avoid breastfeeding while using meperidine HCl and promethazine HCl.

Drug Interactions

Meperidine HCl and promethazine HCl combination drugs can interact with other medications to produce unwanted or unsafe results. Patients should supply a list of all medications, including prescriptions and over-the-counter drugs, to the prescribing physician to avoid potentially dangerous drug interactions.

Meperidine HCl and promethazine HCl can interact with other CNS depressants to enhance the depressive action of both medications to produce respiratory depression, hypotension, profound sedation and coma. Examples of other drugs that depress the central nervous system include tranquilizers, sedatives, general anesthetics, some types of antidepressants, other opioids, and alcohol. When a patient needs both meperidine and the other CNS depressant, physicians should consider reducing the dosages of one or both medications.

Side effects

All medications can cause adverse effects in some consumers. The most serious side effect associated with meperidine is respiratory depression; other serious side effects include circulatory depression, stopped breathing, shock and stopped heartbeat.

The most commonly reported non-serious side effects include lightheadedness, dizziness, sleepiness, nausea, vomiting and sweating. These effects are more prominent in ambulatory patients than in those confined to a bed or wheelchair. Individuals who are not in acute pain are more likely to experience these effects after taking meperidine HCl and promethazine HCl than are consumers who feel significant pain. Lying down may alleviate some of these effects. Doctors should prescribe lower doses to ambulatory patients and to those patients with only moderate pain.

Other side effects include constipation, weakness, headache, dry mouth and mood changes.


Someone can overdose on either the meperidine HCl or the promethazine HCl components of this combination capsule. Both Meperidine HCl and promethazine HCl overdoses are serious and sometimes fatal conditions. Overdose of prescription painkillers like meperidine HCl claims nearly each year. The number of deaths associated with prescription painkillers has tripled in the decade between the years of 1999 and 2008.

Symptoms of serious meperidine overdose include respiratory depression, extreme sleepiness that worsens to coma, limp muscles and cold, clammy skin. Sometimes the victim will experience hypotension and slow heart beat. In cases of severe overdose, the patient may suffer stopped breathing, collapse of the circulatory system, stopped heartbeat and death.

Symptoms of promethazine overdose include deep sedation, coma and seizures. Children receiving large doses of promethazine have experienced hyper-excitability and nightmares.

Meperidine HCl and promethazine HCl overdose requires immediate medical care. Emergency department workers will help the patient breathe by sliding a flexible plastic tube into the patient’s throat to hold his airway open; this tube may be connected to a mechanical ventilator to take over breathing.

Doctors may order naloxone to reverse the effects of respiratory depression only if the patient shows signs of breathing problems. Naloxone will cause withdrawal symptoms in opioid-dependent patients, complicating overdose treatment. Physicians may order anticholinergic antiparkinson agents, diphenhydramine, or barbiturates to treat promethazine overdose.

Nurses will start intravenous fluids and medications including levarterenol or phenylephrine to stabilize blood pressure and other vital signs. Emergency department personnel will perform CPR or other lifesaving measures as necessary.


Recreational drug users target meperidine HCl and promethazine HCl preparations because of the way opioids get them high. The ranks products containing meperidine HCl and promethazine HCl as class II drugs, meaning they pose the same relative risk for abuse as raw opium or the prescription drug, OxyContin. To reduce the risk for abuse, meperidine HCl and promethazine HCl preparations are available by prescription only.

Recreational drug abuse increases the consumer’s risk for experiencing side effects or toxic overdose, or developing an addiction to or physical dependence on meperidine HCl and promethazine HCl.


An opioid-dependent person suffers uncomfortable withdrawal symptoms when he stops taking meperidine HCl and promethazine HCl preparations abruptly. These withdrawal symptoms begin a few hours after the last dose of meperidine HCl and promethazine HCl and last for five or more days. Left untreated, these symptoms fade by themselves and do not return unless the individual once again becomes dependent on opioids. Someone can stop withdrawal symptoms by taking more meperidine HCl and promethazine HCl, but these individuals will continue to be opioid-dependent.

To avoid withdrawal symptoms, physicians suggest patients wean themselves by taking smaller doses of meperidine HCl and promethazine HCl at increasing larger intervals. This tapering method works well for the majority of opioid-dependent people but persistent and severe withdrawal symptoms prevent many people from discontinuing meperidine HCl and promethazine HCl at the appropriate time.


According to the , almost 2 million Americans are opioid-dependent and cannot overcome withdrawal symptoms on their own. To address this widespread need, local hospitals and healthcare institutions now offer detoxification services. Patients receive drugs to counteract the effects of opioids along with a variety of medications to ease multiple withdrawal symptoms. Detoxification lessens the severity but not the duration of the standard detoxification procedure.

Many informed consumers now choose the humane and efficient approach to detoxification - rapid detox. The rapid detox physician sedates and anesthetizes the patient before administering the standard detoxification and anti-withdrawal drugs. The rapid detox patient dozes in a comfortable “twilight sleep” during the difficult detoxification procedure, awakening a few hours later feeling refreshed and revitalized. Rapid detox eases the severity and the duration of detoxification, offering patients a choice.


Meperidine HCl and promethazine HCl should be stored in a tight, light resistant container away from children. Patients and caregivers should store meperidine HCl and promethazine HCl where adults cannot consume this drug by accident or on purpose.

Miscellaneous information

Meperidine HCl and promethazine HCl are red capsules imprinted with "4206/V."