DrugBuyers.Com: Avinza

I, too, have heard that meperidine is used often in hospitals. I have never been told directly WHY this is because I'm in the basic research part of the hospital, but there's a clue that may help: fentanyl is also used a lot. Meperidine (Demerol) and fentanyl are related, with fentanyl being a heck of a lot stronger, as you know. The other similarity is that they have short half-lives, so you can administer analgesia and have the drug get out of there quickly. That's a big plus in the hospital, much more so than in outpatient situations. Also, it has few peripheral side effects to deal with.

By the way, long-term use of Demerol is toxic because one of its metabolites is toxic and builds up in your body. That's why it's not prescribed often for chronic pain. I don't know about fentanyl, but the Duragesic patch is fentanyl, distributed evenly over several days, so I'm guessing the risk is less...

Another thing, if you look at the structure of meperidine vs. morphine, you will notice nothing in common! It actually IS related to morphine, but it's hard to explain. There is one cyclic carbon group and a long strand that contains nitrogen in common. Here's a link to a paper that shows how it's related:

http://holivo.pharmacy.uiowa.edu/morphine/opioids_morphine.pdf

Dilaudid is hydromorphone. You know hydrocodone? Dilaudid/hydromorphone is just hydrocodone with the carbon in the 3 position bound to an OH group instead of an OCH3. That's it! Putting that OH instead of an OCH3 raises its affinity for opiate receptors from 10-100 fold, though, so that little change means a lot.

By the way, this one little change is what separates codeine from morphine, too. Cytochrome P450 2D6 cuts off this CH3 and turns hydrocodone into Dilaudid (and codeine into morphine), and for a long time it was thought that hydro worked by being turned into Dilaudid. Funny that it doesn't FEEL like Dilaudid. These days, this is being questioned because it looks as though only 15% of hydro is converted to Dilaudid, and a lot of people think that hydro's structure has activity on its own. The thing is, as I mentioned above, putting that CH3 there lowers the drug's affinity for the mu opioid receptor by anywhere from 10-100 fold... So somehow, despite hydro's CH3 addition, it still works. But not as fast as Dilaudid. Which is what you asked about...

Dilaudid acts fast, it's potent, and has relatively few side effects, as it's a relatively pure mu opioid receptor agonist, but it is very similar to morphine, so more people are allergic to it than to Demerol.

It's not often prescribed as a pill, though my best's friend's mom had a lot of it. Junkies have found that it feels just like heroin when injected, and is highly sought after by them. See the movie Drugstore Cowboy for an extended proof of this... Here's a link on how close morphine looks to Dilaudid, the relative potencies, alternatives, etc.:

http://holivo.pharmacy.uiowa.edu/morphine/opioids_morphine.pdf

Dilaudid is supposed to have few side effects, but more and more people who are treated with it after surgery are complaining about feeling only localized pain relief, even though it's administered by IV. Plus, some people hallucinate. Some people are allergic to it.

Hope this helps. Any specific questions are welcome.

Noah