Tolerance and physiological dependence can occur with meperidine and other opiate agonists. Also, meperidine should be used cautiously in patients with a history of substance abuse. Patients with head trauma or with increased intracranial pressure should not be given meperidine because it can make it difficult to evaluate neurologic parameters. Hypoventilation can produce cerebral hypoxia and raise CSF pressure, unrelated to and exaggerating the injury. Opiate analgesics should be used cautiously in patients with cardiac disease causing supraventricular dysrhythmias or hypotension.
Opiate agonists can induce vasovagal syncope or orthostatic hypotension.
Because meperidine has atropine-like effects, it should be used with caution in patients with glaucoma. Meperidine should be prescribed extremely cautiously, if at all, to patients with renal disease. Drug accumulation or prolonged duration of action can occur in patients with renal impairment or hepatic disease. Convulsions can be precipitated during use of meperidine in patients with a preexisting seizure disorder or in patients with renal failure. Patients with renal disease may be more prone to urinary retention and oliguria during therapy with meperidine.