O

Alfentanil Remifentanil

Figure 24.9 • 4-Phenylpiperidines and 4-anilidopiperidines.

renal dysfunction, thus cannot eliminate the normeperidine, and those on CYP inducers.81

In addition to the CNS toxicity of normeperidine, meperi-dine has also been found to be a weak serotonin reuptake inhibitor and has been involved in serotonin toxicity reactions when used with monoamine oxidase inhibitors or serotonin reuptake inhibitors.82 Meperidine is available in tablet, liquid, and injectable forms. The use of meperidine should be limited to those patients that have true allergies to the morphine-type opioids, and patients should be monitored for toxicity.

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